Ob-Gyn Coding Alert

You-ll have to wait and see if circumcision change will clarify payment

Although you-ve got plenty of new codes to learn and use for 2007, CPT brings another burden too. Numerous ob-gyn revisions and code reassignments mean you-ve got to make certain you-ve accounted for these important changes -quot; or face shocking reimbursement results.

Increase Your Ultrasound Guidance Specificity

When a procedure requires ultrasound guidance during a surgery, but there is no specific code number that describes the basic procedure -- for instance, ultrasound guidance for IUD removal -- physicians would have reported 76986 in 2006, says Melanie Witt, RN, CPC-OGS, MA, an ob-gyn coding expert based in Guadalupita, N.M. Because of code reassignments, the new code for this procedure is 76998 (Ultrasonic guidance, intraoperative).

Reassign Your Bone Study, Mammogram Codes

You-ll have to alter your codes for ordering bone density studies and mammograms as well. The crosswalk table at right lists the most common codes for procedures ob-gyns order.

Circumcision Revision May Not Be Perfect

Not all revisions mean benefits to coders. -I find it hard to tell if the revision to an existing circumcision code is going to clarify or muddy the waters from a payment perspective,- Witt says. Some obstetricians do perform these procedures, and many also perform a regional dorsal penile or ring block.
 
In 2006, you would have reported a regional dorsal penile or ring block using 64450 (Injection, anesthetic agent; other peripheral nerve or branch) because CPT stipulates that the surgical procedure would include only a local anesthetic. 

The revised code, which you would report regardless of the patient's age, now reads:

- 54150 -- Circumcision, using clamp or other device with regional dorsal penile or ring block.

-We will have to wait and see how payers will interpret this change,- Witt says. 

Don't Miss These Miscellaneous Code Changes

For ob-gyn practices that use the services of a genetic counselor, some good news. CPT 2007 gives you a new code, 96040 (Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/family). Make certain your documentation includes the need for the counseling, the counseling's content, and the total amount of time spent.

In the past, the codes for describing additional hours of hydration (90761), therapeutic infusions (90766), IV chemotherapy (96415) and intra-arterial chemotherapy (96423) stated -each additional hour, up to 8 hours.- In other words, you could not bill beyond eight additional hours. CPT has removed this limit so you may report any number of additional hours for these types of infusions.