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. This includes time spent with parties who have assumed responsibility for the care of the patient or decision making whether or not they are family members (e.g., foster parents, person acting in locum parentis, legal guardian). The extent of counseling and/or coordination of care must be documented in the medical record.


6. Consultation Codes: Revisions were made to the notes outlining the correct use of the consultation codes (99241-99275), found on page 15 of CPT 2000.

Clarification has been added to indicate that the physician consultant may initiate diagnostic and/or therapeutic services at the same or subsequent visit.

Clarification has been added of how to document a
request for a consult: Written or verbal request for a
consult may be made by a physician or other appropriate
source and documented in the patients medical record.
The consultants opinion must be communicated by
written report to the requesting physician, however.
Clarification that in an inpatient hospital setting, the
consulting physician should use the appropriate inpatient
hospital consultation code for the initial encounter. The
subsequent encounter by the same physician in the
hospital setting should be reported using subsequent
hospital care codes (not follow-up consultation codes), if
the physician assumes responsibility for management of a
portion or all of the patients condition.

7. Critical Care: Significant revisions were made to the notes outlining correct use of the critical-care codes starting on page 21 of CPT 2000.

Clarification was added to denote that total duration of time spent by the physician providing critical care services does not imply constant attendance at the bedside, but rather involves the physician devoting his or her full attention to the patient and not providing services to any other patient during the same period of time.

The following was added to the introductory note:

Time spent with the individual patient should be recorded
in the patients record. The time that can be reported as
critical care is the time spent engaged in work directly
related to the individual patients care whether that time
was spent at the immediate bedside or elsewhere on the
floor or unit.

For example, time spent on the unit or at the nursing station on the floor reviewing test results or imaging studies, discussing the critically ill patients care with other medical staff or documenting critical care services in the medical record would be reported as critical care,even though it does not occur at the bedside. Also, when the patient is unable or is clinically incompetent to participate in discussions, time spent on the floor or unit with family members or surrogate decision makers obtaining a medical history, reviewing the patients
condition or prognosis, or discussing treatment or
limitation(s) of treatment may be reported as critical
care, provided that the conversation bears directly on the
medical decision making.

Time spent in activities that occur outside of the
unit or off the floor (e.g., telephone calls, whether taken
at home, in the office, or elsewhere in the hospital) may
not be reported as critical care since the physician is not
immediately available to the patient. Time spent in
activities that do not directly contribute to the treatment
of the patient may not be reported as critical care, even if they are performed in the critical care unit (e.g., participation in administrative meetings or telephone calls to discuss other patients).

8. E/M Services Code Changes: The time definitions for the codes 99291 and 99292 have been specified as 30-74 minutes and each additional 30 minutes beyond the first 74 minutes.

99291Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes.

99292each additional 30 minutes (list separately in addition to code for primary service).

Source for article: Melanie Witt, RN, CPC, MA, program manager, Dept. of Coding and Nomenclature, American College of Obstetricians and Gynecologists.

New Unlisted Codes Each new laparoscopy anatomic site-specific section will contain an unlisted procedure code. New codes: 58578Unlisted laparoscopy procedure, uterus 58579Unlisted hysteroscopy procedure, uterus 58679Unlisted laparoscopy procedure, oviduct, ovary 59898Unlisted laparoscopy procedure, maternity care and delivery

Code Changes for Laparoscopy The following codes for laparoscopy have been reassigned. They now appear in the same category as the appropriate anatomical section for the subject of the laparoscopy, rather than in a separate category. 56300 has been deleted. To report, use 49320(Laparoscopy, surgical, abdomen, peritoneum, and omentum; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) 56301 has been deleted. To report, use 58670 (Laparoscopy, surgical; with fulguration of oviducts [with or without transection]) 56302 has been deleted. To report, use 58671 (Laparoscopy, surgical; with occlusion of oviducts by device [e.g., band, clip, or Falope ring]) 56303 has been deleted. To report, use 58662 (Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method) 56304 has been deleted. To report, use 58660 (Laparoscopy, surgical; with lysis of adhesions [salpingolysis, ovariolysis][separate procedure]) 56305 has been deleted. To report, use 49321 (Laparoscopy; with biopsy [single or multiple]) 56306 has been deleted. To report, use 49322 (Laparoscopy; with aspiration of cavity or cyst [e.g., ovarian cyst] [single or multiple]) 56307 has been deleted. To report, use 58661 (Laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]) 56308 has been deleted. To report, use 58550 (Laparoscopy, surgical; with vaginal hysterectomy with or without removal of tube[s], with or without removal of ovary[s] [laparoscopic assisted vaginal hysterectomy]) 56309 has been deleted. To report, use 58551 (Laparoscopy, surgical; with removal of leiomyomata [single or multiple]) 56310 has been deleted. To report, use 44200 (Laparoscopy, surgical; enterolysis [freeing of intestinal adhesion] [separate procedure]) 56311 has been deleted. To report, use 38570 (Laparoscopy, surgical; with retroperitoneal lymph node sampling [biopsy], single or multiple) 56312 has been deleted. To report, use 38571 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy) 56313 has been deleted. To report, use 38572 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling [biopsy], single or multiple) 56343 has been deleted. To report, use 58673 (Laparoscopy, surgical; with salpingostomy [salpingoneostomy]) 56344 has been deleted. To report, use 58672 (Laparoscopy, surgical; with fimbrioplasty) 56350 has been deleted. To report, use 58555 (Hysteroscopy, diagnostic [separate procedure]) 56351 has been deleted. To report, use 58558 (Hysteroscopy, surgical; with sampling [biopsy] of endometrium and/or polypectomy, with or without D & C) 56352 has been deleted. To report, use 58559 (Hysteroscopy, surgical; with lysis of intrauterine adhesions [any method]) 56353 has been deleted. To report, use 58560 (Hysteroscopy, surgical; with division or resection of intrauterine septum [any method]) 56354 has been deleted. To report, use 58561 (Hysteroscopy, surgical; with removal of leiomyomata) 56355 has been deleted. To report, use 58562 (Hysteroscopy, surgical; with removal of impacted foreign body) 56356 has been deleted. To report, use 58563 (Hysteroscopy, surgical; with endometrial ablation [any method]) 56399 has been deleted. To report, see site-specific unlisted laparoscopy/hysteroscopy procedure codes)