Ob-Gyn Coding Alert

Your options for reporting nuchal translucency just expanded -- here's how If you-ve been holding your breath for codes to represent the latest in laparoscopic hysterectomy procedures and nuchal translucency measurements during pregnancy's first trimester, get ready to exhale.

CPT 2007 brings a slew of changes to ob-gyn coders, and you-ve got to learn them by Jan. 1. Cheer for 2 Laparoscopic Hysterectomy Additions CPT 2007 brings much-needed codes to supracervical laparoscopic hysterectomies as well as laparoscopic radical hysterectomies.

In the past: If an ob-gyn performed a supracervical laparoscopic hysterectomy in 2006, you only had two coding options:

- report one of the codes for a laparoscopically assisted hysterectomy (58550-58554) with modifier 52 (Reduced services) because the ob-gyn did not remove the cervix, or

- report the unlisted-procedure code 58578 (Unlisted laparoscopy procedure, uterus).  As of Jan. 1: Now you have four new codes to accurately report this procedure:

- 58541 -- Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less

- 58542 -- - with removal of tube(s) and/or ovary(s)

- 58543 -- Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g

- 58544 -- - with removal of tube(s) and/or ovary(s). -This is great news, because the new codes will help cut down on all the documentation we-ve been sending to get reimbursed,- says Maureen Murphy, coding specialist at Mt. Kisco Medical Group in New York.

Watch out: CPT has gotten very specific about additional codes that you should not report with these procedures. These include 49320, diagnostic laparoscopy; 57410, exam under anesthesia; 58140, abdominal approach myomectomy; 58150, total abdominal hysterectomy; 58661, laparoscopic removal of tube(s) and or ovary(s); or 58670-58671, laparoscopic tubal ligation procedures.

Don't miss: If you-re looking to see if laparoscopic myomectomy codes are among those listed that you should not report in addition to the new codes, you won't find them -- but that doesn't mean you can report them. -CPT has clarified that this was an oversight on their part when the book went to print,- says Melanie Witt, RN, CPC-OGS, MA, an ob-gyn coding expert based in Guadalupita, N.M.

You should not report 58545 (Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight of 250 grams or less and/or removal of surface myomas) or 58546 (... 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 grams) in addition to the new codes. -When the ob-gyn removes the uterus, you should always include the removal of fibroids contained in the uterus as part of that procedure,- Witt says.

Second, you-ve got a new code for a laparoscopic radical hysterectomy. -Ob-gyns might perform this for invasive cervical cancer,- Witt says.

In a nutshell: In 2006, you would have used the unlisted laparoscopic code (58578) to denote this procedure. But [...]