Ob-Gyn Coding Alert

CPT 2003, which goes into effect Jan. 1, 2003, offers several changes to surgical codes that affect ob/gyn procedure reporting, including those associated with lesion removal, abdominal and bladder surgeries, and colposcopies, among others.

Although this article references specific changes that affect ob-gyn coders, it may not be a complete listing. You should review CPT 2003 to familiarize yourself with all the coding changes that may affect your practice.

"The skin lesion codes have been revised in 2003 to clearly state that they describe a full-thickness removal of the lesion, which includes the margin along with simple closure (if performed)," says Melanie Witt, RN, CPC, MA, an independent coding consultant and educator based in Fredericksburg, Va. "In other words, you should pick the code based on the total amount of tissue removed at that site during the operative session, not just the lesion size."

11420 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less

11421 excised diameter 0.6 to 1.0 cm

11422 excised diameter 1.1 to 2.0 cm

11423 excised diameter 2.1 to 3.0 cm

11424 excised diameter 3.1 to 4.0 cm

11426 excised diameter over 4.0 cm

11620 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less

11621 excised diameter 0.6 to 1.0 cm

11622 excised diameter 1.1 to 2.0 cm

11623 excised diameter 2.1 to 3.0 cm

11624 excised diameter 3.1 to 4.0 cm

11626 excised diameter over 4.0 cm.

CPT 2003 revises 36415 (Collection of venous blood by venipuncture) and adds 36416 (Collection of capillary blood specimen [e.g., finger, heel, ear stick]) to better assign blood collection methods and to delete G0001 (Routine venipunc-ture for collection of specimen[s]). "G codes are Medicare codes, not CPT codes," says Terry Tropin, RHIA, CPC, CCS-P, manager of coding education for the American College of Obstetricians and Gynecologists. Therefore, many private payers do not recognize them. Several G codes, as well as other HCPCS codes, have been replaced with CPT codes to make coding for these services more uniform.

Gynecological oncologists who perform intraperi-toneal chemotherapy in women with ovarian or primary peritoneal cancer may report the new code 49419 (Insertion of intraperitoneal cannula or catheter, with subcutaneous reservoir, permanent [i.e., totally implantable]; for removal, use 49422). When this procedure is performed, it requires an incision and the creation of a pocket for the reservoir.

CPT 2003 has developed three new codes to replace G0002 (Office procedure, insertion of temporary indwelling catheter, Foley type [separate procedure]). "You would report these codes only when the catheter insertion is an independent procedure, not when the insertion is part of another procedure," Witt says. You should note that 53670 and 53675 (catheterization procedures listed under the "urethra" heading) have been deleted and replaced with these new codes that are more appropriate to procedures performed on the bladder.

51701 Insertion of non-indwelling bladder catheter (e.g., straight catheterization for residual urine)

51702 Insertion of temporary indwelling bladder catheter; simple (e.g., Foley)

51703 complicated (e.g., altered anatomy, fractured catheter/balloon)

New code 51798 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging) replaces code 78730, which had been inaccurately placed in CPT's nuclear medicine section. The new code represents a more accurate description of the procedure, which uses a hand-held Doppler ultrasonic device and is noninvasive, Witt explains. This procedure represents only the technical component and is not associated with physician work. Code 51798 will replace G0050 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound).

CPT 2003 now contains new and revised codes for colposcopy of the vulva, cervix and vagina. You should be aware, however, of the following coding guidelines, Witt says:

1. If the ob/gyn performs colposcopy on both the vagina and vulva, you may report both procedures, adding modifier -51 (Multiple procedures) to the code of lesser relative value.

2. A superficial cervical examination is part of an examination of the entire vagina (57420 and 57421), if performed.

3. If the examination's main purpose is to evaluate the cervix rather than the vagina, you would report only the cervical colposcopy codes.

4. Colposcopy of the cervix (57452-57461) includes an examination of not only the entire cervix but also the upper/adjacent portion of the vagina when the physician examines this area or when a cervical lesion extends into the vagina.

5. Code 57460 has been revised and 57461 has been added to clarify the two different cervical loop electrode excision procedures that might be performed with colposcopy. Code 57460 includes removal of the exocervix and perhaps some of the transformation zone if necessary. Code 57461 represents a conization procedure that takes all of the exocervix, the transformation zone and some or all of the endocervix.

6. An endocervical curettage is part of a conization. Therefore, you may not report 57456 in addition to 57461.

56820 Colposcopy of the vulva

56821 with biopsy(s)

57420 Colposcopy of the entire vagina, with cervix if present

57421 with biopsy(s) (For cervicography, see Category III code 0003T.)

57452 Colposcopy of the cervix including upper/ adjacent vagina

57454 with biopsy(s) of the cervix and endocervical curettage

57455 with biopsy(s) of the cervix

57456 with endocervical curettage

57460 with loop electrode biopsy(s) of the cervix

57461 with loop electrode conization of the cervix.

CPT 2003 adds new codes and revises old ones for procedures that involve the removal of uterine fibroids. "CPT makes this change to account for the differences in surgical work with larger or multiple (five or more) fibroids," Witt says. You should note that 58551 (Laparoscopy, surgical; with removal of leiomyomata [single or multiple]) has been deleted. In its place, you should report either 58545 or 58546. CPT has also clarified that the abdominal approach myomectomy codes would not be reported in addition to the abdominal hysterectomy codes (58150-58240).

58140 Myomectomy, excision of fibroid tumor(s) of uterus, 1 to 4 intramural myoma(s) with total weight of 250 grams or less and/or removal of surface myoma(s); abdominal approach 58145 vaginal approach

58146 Myomectomy, excision of fibroid tumor(s) of uterus, 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 grams, abdominal approach

58545 Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight of 250 grams or less and/or removal of surface myomas

58546 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 grams.

The codes listed below have been revised or added in 2003 to account for the additional work involved in removing a large uterus vaginally. The surgeon may remove the larger uterus vaginally by using bisection, morcellation, or myomectomy and coring. When the operative report includes a description of this and the weight of the uterus is confirmed, you may report the new codes for the larger uterine size, Witt says. As with an abdominal hysterectomy, removal of fibroids prior to removing the uterus would be an integral part of the procedure and would not be reported separately.

58550 Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 grams or less

58552 with removal of tube(s) and/or ovary(s)

58553 Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 grams

58554 with removal of tube(s) and/or ovary(s)

58260 Vaginal hysterectomy, for uterus 250 grams or less 58262 with removal of tube(s) and ovary(s) 58263 with removal of tube(s), and/or ovary(s), with repair of enterocele

58267 with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control 58270 with repair of enterocele

58290 Vaginal hysterectomy, for uterus greater than 250 grams

58291 with removal of tube(s) and/or ovary(s)

58292 with removal of tube(s) and/or ovary(s), with repair of enterocele

58293 with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control

58294 with repair of enterocele.