Ob-Gyn Coding Alert

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 [...]