Advanced Search

Ob-Gyn Coding Alert

CPT 2002:

Many Revisions Affect Ob/Gyn

Published on Thu Nov 01, 2001

CPT 2002 features as many or more revisions to existing codes than it does new codes pertinent to ob/gyn. Melanie Witt, RN, CPC, MA, an independent coding educator and ob/gyn coding expert, breaks down the changes most likely to affect ob/gyn coders and explains how they will impact coding and reimbursement for the specialty.

Evaluation and Management Code Changes

Two minor changes have occurred to the codes describing critical care and preventive medicine. First, the notes for critical-care codes have been revised to correlate with the time specifications in the table of examples that explain these codes. The note now reads, "Code 99292 is used to report additional 20-minute block(s) of time beyond the first 74 minutes." The example table also added information on billing periods of 194 minutes or longer.
 
Second, CPT revised the preventive-medicine notes to clarify the definition of the "comprehensive" examination associated with preventive-medicine E/M services. The note now refers to the "comprehensive nature of the service as it reflects an age- and gender-appropriate history/exam" and repeats that this is not synonymous with the comprehensive exam required by the problem E/M codes (99201-99350).
 
Because of this change, the nomenclature of the new patient and established patient preventive-medicine codes has been revised. The revision applies only to the nomenclature that appears in front of the semicolon, which is part of the definition of each subsequent indented code.
 

  • 9938x initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, new patient ...
     
  • 9939x periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, established patient ... .

    Surgery Changes

     One of the first big changes to the surgery section of CPT is the revision of the description of services included in the surgical package. In CPT 2002, each of the services included is itemized separately. CPT now formally addresses that one related E/M service just prior to the surgery is included in the package. Many coders will see the similarity to the wording that appears in the Medicare surgical guidelines, which states, "... the following services are always included in addition to the operation per se:
     

  • Local infiltration, metacarpal/metatarsal/digital block or topical anesthesia.
     
  • One related E/M encounter on the date immediately prior to or on the date of procedure (including history and physical), subsequent to the decision for surgery.
     
  • Immediate postoperative care, including dictating operative notes, talking with the family and other physicians.
     
  • Writing orders.
     
  • Evaluating the patient in the postanesthesia recovery area.
     
  • Normal, uncomplicated postoperative follow-up care."


    The CPT editorial panel decided to end the confusion regarding the fine-needle aspiration code in the laboratory section of CPT and developed two new codes for this procedure, placing them at the beginning of the Integumentary System section of CPT:
     

  • 10021 fine needle aspiration; without imaging guidance
     
  • 10022 ... with imaging guidance.
     
    Notes following these codes instruct coders to report 76003, 76360 or 76942 if the physician also does radio-logical supervision and interpretation.
     
    The parenthetical note under 19100 (biopsy of breast; percutaneous, needle core, not using imaging guidance [separate procedure]) instructs the coder to use the new codes for fine-needle aspiration of the breast. The laboratory evaluation of the aspirate will be reported by 88172 or 88173. With the addition of these two surgical codes, the existing laboratory codes 88170 and 88171 used previously for superficial and deep-tissue fine-needle biopsy were deleted from CPT.
     
    A revision to the code for extracorporeal chemotherapy clarifies that it includes chemotherapy perfusion, so it would not be correct to report the chemotherapy administration codes 96408-96425 in addition.
     
  • 36823 insertion of arterial and venous cannula(s) for isolated extracorporeal circulation including regional chemotherapy perfusion to an extremity, with or without hyperthermia, with removal of cannula(s) and repair of arteriotomy and venotomy sites.
     
    This revision resulted in a change to the explanatory note preceding the Chemotherapy Administration section of CPT:
     
    "Regional (isolation) chemotherapy perfusion should be reported using the codes for arterial infusion (96420-96425). Placement of the intra-arterial catheter should be reported using the appropriate code from the Cardiovascular Surgery section. Placement of arterial and venous cannula(s) for extracorporeal circulation via a membrane oxygenator perfusion pump should be reported using code 36823. Code 36823 includes dose calculation and administration of the chemotherapy agent by injection into the perfusate. Do not report code(s) 96408-96425 in conjunction with code 36823."


    Code 57022 has been revised to make the terminology more consistent with other codes that refer to the postpartum period:
     

  • 57022 incision and drainage of vaginal hematoma; obstetrical/postpartum.


    Two new codes have been added to allow gyn/oncologists to report separately their surgical part of clinical brachytherapy. Before this addition, the only way to report these procedures was to add modifier -62 (two surgeons) to the clinical brachytherapy code reported by the therapeutic radiologist. These codes are being added to the Female Genitourinary System section of CPT under the headings of Vagina, Introduction and Corpus Uteri.
     

  • 57155 insertion of uterine tandems and/or vaginal ovoids for clinical brachytherapy.
     
    In this procedure, a tandem, i.e., hollow cylinder, is inserted into the uterus. A long tube is connected to the tandem to permit introduction of the radioactive material into the tandem from outside the vaginal orifice. Two ovoids are placed in the upper part of the vagina, and a long arm is hooked to each ovoid cylinder to allow the introduction of radioactive elements. The ovoids are carefully packed in place to protect the bladder and rectum from radiation damage. The therapeutic radiologist will apply the radioactive element through these tubes into the cylinders at either the same session or a later session. This delivers a high dose of radiation to the cervix.

     

  • 58346 insertion of Heyman capsules for clinical brachytherapy.
     
    This procedure involves inserting Heyman (afterloading) capsules into the uterine cavity. The number of capsules will usually vary from patient to patient and depends on the size of the uterus. As few as four to five or as many as 12 to 15 capsules may be inserted, and long tubes connect the capsules to the outside of the vaginal outlet. A therapeutic radiologist will apply the radioactive element through these tubes into the capsules to deliver a high dose of radiation to the body of the uterus either at the same session or at a later session.
     
    With the addition of these two codes, the explanation of how to report these services under the heading Clinical Brachytherapy in the Radiation Oncology section of CPT has been revised:
     
    "Clinical brachytherapy requires the use of either natural or man-made radioelements applied into or around a treatment field of interest. The supervision of radioelements and dose interpretation are performed solely by the radiation oncologist."
     
    For insertion of ovoids and tandems, use 57155. For insertion of Heyman capsules, use 58346.
     
    Two new codes were added to permit gyn oncologists to report two common surgical combinations when dealing with ovarian cancer. These codes are under the heading Ovary, Repair in the CPT book:
     
  • 58953 bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking
     
  • 58954 bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking; with pelvic lymphadenectomy and limited para-aortic lymphadenectomy.

    Other Changes


    CPT added one new code to the antepartum services section of the book dealing with amniocentesis, and revised 59000 as a consequence:
     

  • 59000 amniocentesis; diagnostic
     
  • 59001 amniocentesis; therapeutic amniotic fluid reduction (includes ultrasound guidance).
     
    Although 59001 includes ultrasound guidance, a diagnostic amniocentesis does not, and it may be coded using 76946 (ultrasonic guidance for amniocentesis, imaging supervision and interpretation).


    As the CPT book moves closer to the CPT-5 version, we will continue to see more revisions to provide consistency within the code definitions. Revisions of this type for 2002 include the following:
     

  • Replacing references to "any method" with more concrete examples.
     
  • Destruction methods for vulvar and vaginal lesions (56501, 56515, 57061 and 57065) include "laser surgery, electrosurgery, cryosurgery and chemosurgery."
     
  • Hysteroscopy with endometrial ablation (58563) can include endometrial resection, electrosurgical ablation or thermoablation.


    Five instances of nomenclature were standardized:
     

  • Cauterization changed to "cautery" for 57510.
     
  • Fibroid tumor changed to "leiomyomata" for 58140.
     
  • Colpectomy changed to "vaginectomy" for 58275.
     
  • Cesarean section changed to "cesarean delivery" for 58611.
     
  • Echography changed to "ultrasound" for 76805, 76830 and 76856.
     
    CPT also added two new codes for open and percutaneous sacral nerve stimulation in the treatment of urinary incontinence, and revised an existing code to exclude the sacral nerve:
     
  • 64555 percutaneous implantation of neurostimulator electrodes; peripheral nerve (excludes sacral nerve)
     
  • 64561 ... sacral nerve (transforaminal placement)
     
  • 64581 incision for implantation of neurostimulator electrodes; sacral nerve (transforaminal placement).

    Diagnostic Radiology Changes


    CPT has revised the list of codes that can be reported with 76095 (stereotactic localization guidance for breast biopsy or needle placement [e.g., for wire localization or for injection], each lesion, radiological supervision and interpretation) and 76096 (mammographic guidance for needle placement, breast, [e.g., for wire localization or for injection], each lesion, radiological supervision and interpretation).
     
    The codes that may be reported in addition to 76095 are 19102, 19103 and 10021. The codes that may be reported in addition to 76906 are 19000, 10103 and 10021.
      
    CPT made a minor revision to 76819 to take out the word "stress" from the original definition:
     

  • 76819 fetal biophysical profile; without nonstress testing.
     
    CPT also added a note on billing for a biophysical profile in multiple gestation, clarifying that for the second and any additional fetuses 76818 (fetal biophysical profile; with non-stress testing) or 76819 should be reported separately with modifier -51 (multiple procedures) added.

    Laboratory Changes


    Minor changes occurred to the following laboratory codes. The term "qualitative" was added to code 82270.
     

  • 82270 blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, 1-3 simultaneous determinations.
     
     
    Two new types of service were added to the Medicine section of CPT. The first deals with home visits for a specific treatment for the patient, and the second with home infusions. Of the new codes, the following may be of use to ob/gyns:
     
  • 99500 home visit for prenatal monitoring and assessment to include fetal heart rate, non-stress test, uterine monitoring, and gestational diabetes monitoring
     
  • 99501 home visit for postnatal assessment and follow-up care
     
  • 99506 home visit for intramuscular injections
     
  • 99507 home visit for care and maintenance of catheter(s) (e.g., urinary, drainage, and enteral)
     
  • 99553 home infusion for tocolytic therapy, per diem
     
  • 99561 home infusion of hydration therapy, per diem.


    Modifier -60 (altered surgical field), which was inadvertently left off the inside cover of CPT 2001 and never accepted by Medicare or any other carrier, was deleted.

    • Other Articles in this issue of

    Ob-Gyn Coding Alert

    View All