Ob-Gyn Coding Alert

New Category III codes rely on Gailrisk score

CPT 2004 moves to update its vaccine and toxoids section to more readily reflect today's administration methods and to include a new code for pain pump refilling.

Take 99025 Off Your Charge Slip
 
CPT 2004 deletes 99025 (Initial [new patient] visit when starred [*] surgical procedure constitutes major service at that visit). This is CPT's first step to eliminate all "starred" procedures over the next few years. In addition, a new instruction for 99080 (Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form) indicates that you should not report this code with the work- related or medical disability evaluation codes 99455 and 99456 because CPT includes the completion of the workers' compensation forms in the service these codes describe.
 
But remember that this is CPT's general version of how the workers' compensation system works, says Terry A. Fletcher, BS, CPC, CCS-P, CCS, CMSCS, a healthcare coding consultant based in Laguna Beach, Calif., and American Academy of Professional Coders (AAPC) National Advisory Board member. "You still need to maintain your state-specific guidelines for this payer. If your state allows you to bill/code differently, then make sure you follow your state rules."
 
CPT revises two other codes in the Miscellaneous Services section:

99024 - Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related  to the original procedure
 
99050 - Services requested after posted office hours in addition to basic service.
 
Update Your Vaccine Coding

You won't be using 90659 in 2004 because CPT deletes it to reflect the fact that the influenza whole-virus vaccine is no longer manufactured and used. You should be using either 90657 or 90658 for the split-virus influenza vaccine. In addition, there are some new vaccine codes and a revision to established codes (90703-90708, 90718, 90727 and 90733) to delete references to "jet injection" as a mode of delivery.
 
The Vaccines and Toxoids section also includes several new codes for 2004, including:

90698 - Diphtheria, tetanus toxoids, acellular pertussis vaccine, haemophilus influenza Type B, and   poliovirus vaccine, inactivated (DTaP - Hib - IPV), for  intramuscular use

90715 - Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), 6 years and younger, for intramuscular use
 
90734 - Tetravalent conjugated meningococcal vaccine (any group[s]), for subcutaneous use

Pain Pump Coding Changes for 2004

CPT 2004 adds 95991 (Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal [intrathecal, epidural] or brain [intraventricular]; administered by physician) so that ob-gyns can report refilling and maintaining implantable pumps or reservoirs for drug delivery. The typical patient will be one with severe cancer-related pain, and gynecologic oncologists probably will be using this code most, says Judy Troy, an ob-gyn coder with 35 years of experience and surgical coding coordinator for Capital Women's Care in Silver Spring, Md. You should use 95990 only when a nonphysician provides the service.
 
Be sure to check your insurance contracts for coverage of this service, Fletcher says. "Many insurers feel that this is an inherent part of a major surgery and will not pay separately for it. So when you are negotiating your contracts, make sure you include reimbursement for this."

Don't Forget the Category III Codes

You must report Category III codes rather than an unlisted-procedure code when the ob-gyn performs a procedure they describe. But remember that T codes are temporary and refer to new technologies, and some payers refuse to reimburse them, Fletcher notes.
 
CPT 2004 provides two new codes you should use if the patient has a personal history of breast cancer (V10.3) or a Gail risk score of 1.7 percent or higher: 0046T (Catheter lavage of a mammary duct[s] for collection of cytology specimen[s], in high-risk individuals [Gail risk scoring or prior personal history of breast cancer], each breast; single duct) and 0047T (... each additional duct). There is no diagnostic code to indicate this risk score, but some alternative codes may be V16.3 (Family history of breast cancer) and V15.89 (Other specified personal history presenting hazards to health). (For more information on the Gail risk score, see "New Codes Require Familiarity With Gail Risk Model" below.)
 
"My physicians say they don't use the Gail risk model information or pass it along to their patients as much as they should," Troy says. The new codes "will be an excellent reminder for them," she adds.
 
In addition, CPT provides several more new Category III codes:
 
0058T - Cryopreservation; reproductive tissue, ovarian
 
0059T - ... oocyte(s)

0060T - Electrical impedance scan of the breast, bilateral (risk assessment device for breast cancer).
  
CPT also clarifies that if your ob-gyn performs imaging guidance along with new code 0061T (Destruction/reduction of malignant breast tumor including breast carcinoma cells in the margins, microwave phased array thermotherapy, disposable catheter with combined temperature monitoring probe and microwave sensor, externally applied microwave energy, including interstitial placement of sensor), you can bill it separately using either 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) or 76986 (Ultrasonic guidance, intraoperative).


New Codes Require Familiarity With Gail Risk Model

With CPT 2004 introducing new Category III codes based on the Gail risk model, make sure you are aware of it to ensure you're properly reporting your ob-gyn's services.
 
The Gail risk model is a computer program that uses family history and medical history to estimate a woman's chances of developing breast cancer in the next five years. The Gail risk score, which you can calculate via the Web site http://medcalc3000.com/Gail99.htm, estimates general risk.
 
To use the Gail model, the computer program asks for information about a number of factors that could increase a woman's risk. These factors include: