Ob-Gyn Coding Alert

In a program memo dated Aug. 10, 2000, the Health Care Financing Administration (HCFA) corrected the relative value units (RVUs) for several CPT codes. Most significant to ob/gyn professionals is the change for code 58100* (endometrial sampling [biopsy] with or without endocervical sampling [biopsy], without cervical dilation, any method [separate procedure]).

HCFA made an error in calculating the RVU for this procedure in its original 2000 Medicare Physician Fee Schedule in a non-facility site of service, and has reconfigured the RVU at a higher value. The increase of 22.5 percent will mean a difference of about $12-$14 per procedure when it is performed in an office setting, which can add up over a year.

Not only has the RVU been raised, but the memo explains that effective Oct. 5, 2000 (when the change takes effect), claims can be resubmitted retroactive to Jan. 1, 2000. But it is up to the providers, not Part B carriers, to adjust payments for all the 58100s performed up to now. Per the memo, Carriers need not search their files to either retract payment for claims already paid or to retroactively pay claims. But carriers should adjust claims brought to their attention. Ob/gyn coders who resubmit should do so with a copy of the HCFA memo, available at www.hcfa.gov/pubforms/transmit/B0040.pdf, and a cover letter explaining that you are not submitting a duplicate claim, rather you are resubmitting a claim for adjustment per HCFAs direction.