Ob-Gyn Coding Alert

Here are the American Medical Associations changes to CPT 2000 most pertinent to ob/gyn practices. The most relevant changes are in laparoscopy, where dozens of codes have been reassigned to their corresponding anatomic sections.

1. Laparoscopy Changes (reassigned code numbers): The laparoscopy/hysteroscopy codes (56300-56399) have been renumbered and relocated to appear in the appropriate anatomic site-specific sections of CPT. For example, laparoscopic aspiration of ovarian cyst(s) (previously listed as 56306) will be listed as code 49322 under a new heading titled Laparoscopy under the Abdomen, Peritoneum, and Omentum subsection of the digestive system. Similarly, hysteroscopy with endometrial ablation (previously listed as 56356) will be listed as code 58563 under a new heading titled Laparoscopy/Hysteroscopy under the Corpus Uteri subsection of the Female Genital System.

2. Surgical Services Code Changes: New surgical services codes have been added, several of which are particularly relevant for ob/gyn practices:

11980Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellets beneath the skin)

13133Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia,hands and/or feet; each additional 5 cm or less (List separately in addition to code for primary procedure.)

Note: Use 13133 in conjunction with code 13132 (repair, complex. forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm). Code 13300 has been deleted. To report, see 13102, 13122, 13133 and 13153.

3. Laboratory Services Code Changes: New codes for ob/gyn laboratory services are as follows:

82120Amines, vaginal fluid, qualitative (For combined pH and amines test for vaginitis, use 82120 and 83986)

88148Cytopathology smears, cervical or vaginal; screening by automated system with manual rescreening under physician supervision

Other Changes to CPT 2000 are More General

4. Modifier Changes: Modifier -91 (repeat clinical diagnostic laboratory test) was added to report the repeat of the same laboratory test on the same day to obtain subsequent (multiple test) results, not to confirm initial results. This modifier will eventually replace the HCPCS modifier -QR (repeat laboratory test performed on the same day).

Modifier -32 (mandated services) was revised to expand examples of mandated services to include governmental, legislative or regulatory requirements.

Note: No modifiers have been deleted.

5. E/M Guideline Changes: A revision to the notes for E/M guidelines, found on page 8 of CPT 2000, now include counseling and/or coordination of care related to other legally responsible individuals. The new language is italicized:

When counseling and/or coordination of care dominates (more than 50 percent the physician/patient and/or family encounter (face-to-face time in the office or other outpatient setting or floor/unit time in the hospital or nursing facility), then time may be considered the key or controlling factor to qualify for a particular level of E/M services. [...]