Ob-Gyn Coding Alert

In some cases, the new CCI bundles only 51701 and 51702, in others it bundles 51701-51703, and in still others it includes all of the above-listed codes. "The majority of the time, however, each of these codes, when bundled, does not allow a modifier to bypass the edit," Witt says. For instance, you can bypass the edit when the colposcopy codes are bundled in the vulvar procedures, but cannot do so when they are bundled  into vaginal procedures. You can use a modifier to bypass these new edits only when bundled into the following comprehensive codes: 56405-56441, 56515-56605, 56620-56632, 56634-56800, 56810, 57023, 57287, 59400, 59410, 59510, 59515, 59610, 59614, 59618 and 59622.

Version 9.0 also bundles several procedures into the hysterectomy codes (58150-58285) and added a large number of bundled procedures to the codes used to report ovarian, tubal and peritoneal cancer surgery (58950-58960). "The good news is that you can bypass almost all of these bundled procedures with a modifier if they are shown to be 'distinct,'" Witt explains. Medicare, however, will never pay separately for the myomectomy code (58146, Myomectomy, excision of fibroid tumor[s] of uterus, 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 grams, abdominal approach) when bundled. Selected additional code pairs that cannot be billed together under any circumstances are 57454 with 57455 or 57456; 57460 with 57455; 58200 with 58290 or 58552-58554; 58950 with 58960; and 58952 with 58200-58210 or 58960.

"Our practice does hysterectomies and procedures for ovarian, tubal and peritoneal cancers routinely," says Katie Thompson, RHIA, a surgical coder at Southeastern Gynecologic Oncology in Atlanta. These surgeries are often multiple procedures, she says. "We will be able to bypass the edits with the correct modifier, but the key is these procedures must be shown to be distinct by determining if a separate diagnosis exists for each procedure." Consequently, coders should review the path and operative reports for this additional information to justify billing these procedures separately, Thompson suggests.

"Because of the number of bundles this time, you should obtain a copy of CCI version 9.0," Witt says. You can purchase this information from sources such as the U.S. Government Printing Office or private vendors, or you can download a copy of selected codes from the American College of Obstetricians and Gynecologists' Web site (www.acog.org) if your physician is a member of this medical-specialty society.

For a list of the CCI edits for the new CPT codes that affect ob-gyn practices, see the chart in article 3.