Ob-Gyn Coding Alert

Jan. 1 is right around the corner, meaning 'tis the season for CPT 2010. You won't have much to master -- just three new codes and some clarifications -- but is that really good news?

It's a mixed bag, coders say. While you won't be too hampered learning new codes for 2010, you also won't have some of your lingering coding issues resolved. "I'm disappointed," says Ann Moll, CMOM, CHCO, CHCC, practice administrator for a private ob-gyn practice in Carrolton, Texas. "It's been a long time since CPT broke down codes to allow more descriptive, precise procedures and prevent procedure bundling."

Don't fall into the trap of being apathetic. You have to implement a new vaginal graft code, a new code for markers for radiation therapy guidance, adhere to new fetal shunt and fetal invasive procedure clarifications, avoid one major laboratory code pitfall, and rely on a new reproductive testing unlisted code for procedures that don't have an existing CPT code.

If your ob-gyn performs urogynecological procedures, you'll want to add 57426 (Revision [including removal] of prosthetic vaginal graft, laparoscopic approach) to your coding arsenal. This code "has been developed to describe the revision of a prosthetic vaginal approach -- which is widely performed," according to an American College of Obstetricians and Gynecologists' (ACOG) email update.In other words, "this change simply represents completing the 'code set' for a vaginal graft revision," says Melanie Witt, RN, CPC, COBGC, MA, an ob-gyn coding expert based in Guadalupita, N.M.

In 2006, the AMA added the code for the vaginal approach (57295, Revision [including removal] of prosthetic vaginal graft; vaginal approach). Then in 2007, they added the code for the abdominal approach (57296, Revision [including removal] of prosthetic vaginal graft; open abdominal approach). "And now we have a code for the laparoscopic approach," Witt says. "All three accomplish the same procedure, but just  via a different surgical approach."

Also: In your 2010 CPT book, when you check the Endoscopy heading under the "Female Genital System (Vagina, Repair)" subsection, you'll find a revision. It will state "Endoscopy/Laparoscopy" (emphasis added) since you have laparoscopic procedure codes in this section.

For more urogynecological additions, see "Prepare For Big Changes in Your Urodynamics Coding" on page 115.

Until Jan. 1, you were limited to an unlisted code when your ob-gyn puts in gold seed markers prior to radiation therapy. With the addition of 49411 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], percutaneous, intraabdominal,intra-pelvic [except prostate], and/or retroperitoneum, single or multiple), this all changes.

Rationale: CPT created this new code to capture a percutaneous, intra-abdominal, intrapelvic, and/or retroperitoneal approach. "The patient, for instance, might have adenocarcinoma of the ovaries and the patient will be having radiation therapy. The ob-gyn inserts gold seed markers to act as a guide for the future interstitial radiation therapy," Witt explains.

Watch out: You'll report 49411 once -- no matter how many markers the ob-gyn places. You can bill for the device supply separately. Also, if the ob-gyn used imaging guidance to place the markers, you can bill that separately (such as 76942, Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation).

You may already know that 59897 (Unlisted fetal invasive procedure, including ultrasound guidance) describes an unlisted fetal invasive procedure which includes ultrasound guidance the ob-gyn performs. To clarify, CPT added "when performed." That means you should still report this code, even when the ob-gyn does not use ultrasound guidance.

In addition, you'll find your CPT 2010 book has a revised Antepartum Services category. You'll see it published with these new cross-reference notes (emphasis added):

Benefit: "Because this information immediately follows the category heading, you're less likely to miss it," Witt cheers.

You shouldn't report multiple panel codes that include any of the same constituent analytes for the same patient collection. That's what the newly revised introductory language in the "Organ or Disease-Oriented Panels" subsection of the "Pathology and Laboratory" portion of your CPT book warns.

Translation: You should "report the most comprehensive panel and individual codes for the tests performed," according to ACOG's advice.

In accordance with this change, CPT deleted the parenthetical notes following panel codes 80047, 80053, and 80076. The term "analytes" is now "tests," and the guidelines conclude with the phrase "(e.g., do not report 80047 in conjunction with 80053)." Also, CPT corrected all references to 83210 to state, "Calcium, total," since this is 83210's descriptor.

Obstetric highlight: You have a revised code reference for an obstetric panel (80055, Obstetric panel). It states, "When syphilis screening is performed using a treponemal antibody approach [new code 86780, Treponema pallidum)], do not use 80055. Use the individual codes for the tests performed in the obstetric panel." That means if your obgyn does not perform 86592 (Syphilis test; qualitative [e.g.,VDRL, RPR, ART]) as part of the panel, your ob-gyn should order 86780 instead. "In that case, the panel code (80055) no longer applies," Witt says. "You would itemize each test performed."

In 2009, CPT deleted category III code 0058T (Cryopreservation, reproductive tissue, ovarian). If your ob-gyn is still performing this service, you should refer to a new reference following 89335 (Cryopreservation, reproductive tissue, testicular). It says you should assign 89240 (Unlisted miscellaneous pathology test) for the cryopreservation of ovarian reproductive tissues.

In addition, CPT added an unlisted code (89398, Unlisted reproductive medicine laboratory procedure) for situations where you might not have a code for reproductive medicine testing.