Ob-Gyn Coding Alert

To get the full overview of CPT 2008, you and your physicians will need to pay particular attention to code renumbering and revisions. If you don-t, you could face dire consequences.

"I review code clarifications even more closely than new codes," says Arlene Smith, CPC, CCS-P, health insurance coding specialist at Tacoma Women's Specialists in Tacoma, Wash. "Clarifications give updated information regarding the use of codes already in circulation and may have subtle changes that will affect the way you use them."

CPT 2008 reassessed codes that AMA has previously designated as modifier 51 (Multiple procedures) exempt.

What that means: "Modifier 51 exempt" means that you don't need to add this modifier to a code that CPT has not designated as an add-on procedure/service, says Diane Hoffman, CPC, coder/biller for Melius, Schurr and Cardwell LP, Physicians for Women, in Madison, Wis. These are typically codes that do not involve significant pre- or postoperative work.

The withdrawal of the modifier 51 exemption status means that 36660 (Catheterization, umbilical artery, newborn, for diagnosis or therapy) will now require a modifier when your ob-gyn performs this service with other procedures.

On the other hand, 51797 (Voiding pressure studies [VP]; intra-abdominal voiding pressure [AP] [rectal, gastric, intraperitoneal]) will become an add-on code that does not take a modifier 51. In other words, as of Jan. 1, you-ll bill 51797 only if you-re also reporting 51795 (Voiding pressure studies [VP]; bladder voiding pressure, any technique).

If you have the old codes memorized for bladder aspiration, you will need to relearn them. CPT has tinkered with the codes- placement and has decided that the bladder aspiration codes are more appropriately placed under "Bladder, Removal" rather than "Bladder, Incision."

The new numbers are:

- 51100 -- Aspiration of bladder; by needle

- 51101 -- - by trocar or intracatheter

- 51102 -- - with insertion of suprapubic catheter.

On the bright side: You-ll use the codes the same way as you did previously.

CPT 2008 contains four more clarifications that you should definitely take note of.

If you are billing 82272 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative, feces, single specimen [e.g., from digital rectal exam]) for the annual fecal occult blood screening test, CPT has revised the code to make it clear that you should not report this code for a screening test: Blood, occult, by peroxidase activity [e.g., guaiac], qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening.

The only two CPT codes that you can use for the screening fecal occult blood test are 82270 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening [i.e., patient was provided three cards or single triple card for consecutive collection]) or 82274 (Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations). The immunoassay test may be physician-collected (except on a Medicare patient), but the patient must collect the guaiac test specimen herself.

Next, the new descriptor for 57500 specifically refers to the cervix as the location for the biopsy or lesion excision. Prior to the change, only the subheading title gave any indication of this location.

Third, if your physician performs a laparoscopic assisted (58550-58554), total (58570-58573) or supracervical (58541-58544) hysterectomy, CPT has added a list of codes you may not report in addition. These codes include:

- 49320 (diagnostic laparoscopy)

- 57000 (colpotomy)

- 57180 (hemostatic vaginal packing)

- 57410 (EUA)

- 58140-58146, 58545-58546, 58561 (myomectomy)

- 58661 (removal of tubes and/or ovaries)

- 58670-58671 (tubal ligations).

And CPT has clarified that to bill 93975 or 93976 (Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs ...), documentation must show that the exam's purpose was to evaluate the vascular structures. In other words, if your physician used color Doppler to identify anatomic structures at the time of an ultrasound, you may not bill either of these two codes in addition.

CPT 2008 creates a new subsection for reproductive system procedures and has established the first code in this section, which may affect your ob-gyn oncologists.

You can report new code 55920 (Placement of needles or catheters into pelvic organs and/or genitalia [except prostate] for subsequent interstitial radioelement application) in addition to codes for the placement of uterine tandems or vaginal ovoids (57155) or Heyman capsules for clinical brachytherapy (58346). The code description indicates that if the physician places the needles in both pelvic organs and the genitalia, you-ll only report the code once.