Ob-Gyn Coding Alert

You may have an extra $185 heading your way -- here's why.

To boost your bottom line as well as help avoid disastrous denials next year, you need to highlight these vaginal mesh, anesthesia, and HPV changes.

Recoup Mesh Pay Under These Circumstances

Although you may search your CPT book for new codes, they aren't the only changes to affect your claims next year. You should also check out the new notes added to existing codes.

For instance, add-on code +57267 (Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site [anterior, posterior compartment], vaginal approach [List separately in addition to code for primary procedure]) didn't change in 2009

 -- but the parenthetical note following the descriptor did.

It states, -Use 57267 in conjunction with 45560, 57240-57265, 57285.- Allowing you to report +57267 in addition to 57285 (Paravaginal defect repair [including repair of cystocele, if performed]; vaginal approach) has experts buzzing.

-The issue is still whether your ob-gyn documented the need for the graft (such as weakened tissue) in the op report,- says Melanie Witt, RN, CPC-OBGYN, MA, an independent ob-gyn coding consultant in Guadalupita, N.M.

Example: A patient has a lateral cystocele that requires repair (57285).  The native tissue (pubocervical fascia), however, is weak and will not hold sutures. Therefore, the physician elects to shore up the repair by using the mesh (+57267). In 2008

you could not report the mesh, but in 2009, you can.

Good news: That's an additional $185.86 (4.88 work relative value units [RVUs] x 38.0870 using the 2008 Medicare Physician Fee Schedule) your practice can recoup.

Watch out: The Correct Coding Initiative (CCI) added +57267 as a bundled code with 57285 in Jan. 2008. This edit, however, has a modifier indicator of -1- which means you can use a modifier to bypass the edit -- so long as the mesh was in a

different location than the actual repair. Check back with the Ob-Gyn Coding Alert to see if CCI will remove this edit entirely in 2009.

Reserve 57400-57415 For Under General Surgeries

You should note the revision in the following codes (emphasis added):

- 57400 ��" Dilation of vagina under anesthesia (other than local)

- 57410 ��" Pelvic examination under anesthesia (other than local)

- 57415 ��" Removal of impacted vaginal foreign body (separate procedure) under anesthesia (other than local).

Break it down: -The addition of -other than local- mainly iterates that by anesthesia, CPT means other than local,- Witt says. In other words, -you need regional or general anesthesia to report them.- Expect the exam under anesthesia (EUA),

which the Correct Coding Initiative (CCI) bundles into all procedures, to continue to be a -look-see- procedure.

Combat 90650 Denials With Added PMS Verbiage

Lastly, CPT 2009 makes HPV code 90650 (Human Papilloma virus [HPV] vaccine, types 16, 18, bivalent, 3 dose schedule, for intramuscular use) official. -This code was in effect for 2008 but didn't make it into CPT 2008, so some practices had

to battle their payers to get it recognized,- says Orinda Marcus of Big Sky Billing in Helena, Mont. 

The addition of the HPV code substantiates revised text tacked onto the -Preventive Medicine Services- section. The added note advises you to separately report -vaccine/toxoid products, immunization administrations, ancillary studies involving

laboratory, radiology, other procedures or screening tests - identified with specific CPT code.-