Ob-Gyn Coding Alert

New HPV vaccine code will be valid in 2008 but won't appear in your CPT book CPT 2008 adds long-awaited codes for paravaginal defect repairs and total laparoscopic hysterectomies -- but you-ll need to make certain your ob-gyn knows their documentation must include key elements to ensure you report them properly. Our experts break down five areas of code additions. You-ll learn what they are and how you should use them -- and what code combinations you should avoid. 1. Prepare for Paravaginal Defect Repair Changes First, two new codes and one revised code will make documentation specifying the paravaginal defect repair approach more important than ever before. CPT 2008 brings you one old (57284) and two brand-new codes: - 57284 -- Paravaginal defect repair (including repair of cystocele, if performed); open abdominal approach - 57285 -- - vaginal approach - 57423 -- Paravaginal defect repair (including repair of cystocele, if performed), laparoscopic approach. Good news: "The surgeon needs to be clear whether the case was open, vaginal or laparoscopic. As long as you have that, your choice of paravaginal repair code is obvious," says Harry Stuber, MD, FACOG, CPC-OGS, an independent gynecologist in Cookeville, Tenn. Be cautious: Before you cheer for this CPT clarity, you need to take into account some bundles attached to the new codes. For instance, although CPT did remove references to stress urinary incontinence and/or incomplete vaginal prolapse from the revised and new codes, you should still include the cystocele repair by any method, says Melanie Witt, RN, CPC-OGS, MA, a coding expert based out of Guadalupita, N.M. "You-ll find that CPT 2008 lists codes that you cannot report in addition to these paravaginal defect repair codes," Witt says. In general, you should avoid urethropexy codes 51840, 51841, 51990, 58152, and 58267 and the cystocele repair codes 57240 and 57260, and enterocele repair code 57265 when your ob-gyn performs a paravaginal defect. Red flag: "Physicians should also watch for any Correct Coding Initiative (CCI) bundles assigned by Medicare to these new codes, especially whether they are different than those that CPT lists," Witt says. For instance, in the past, CCI permanently bundled 57288 (Sling operation for stress incontinence [e.g., fascia or synthetic]) into 57284. If CCI does not remove this bundle in 2008, physicians should contact the American College of Obstetricians and Gynecologists (ACOG) and encourage the organization to discuss this inappropriate bundle with Medicare, Witt says. 2. Tally Up Total Laparoscopic Hysterectomy Changes Second, you-ll have four new codes for total laparoscopic hysterectomies in 2008. Background: For some time now, surgeons have been able to perform a hysterectomy by completely detaching both the uterine cervix and body of uterus from their surrounding support structures [...]