Ob-Gyn Coding Alert

Heads up: These two deleted codes have replacements.

Have you been searching for a code to reflect PAMG-1 when your ob-gyn wants to determine whether fetal membranes have ruptured? If so, CPT 2011 brings welcome relief in the form of 84112 (Placental alpha microglobulin-1 [PAMG-1], cervicovaginal secretion, qualitative). Code 84112 is among a handful of new codes that could solve tricky claims you may be facing now. Be the first coder to glean what else is potentially new for your ob-gyn practice, so that you can be proficient when Jan. 1 hits.

Caveat: Advice and information about the other new, revised, and deleted codes for 2011 should be clarified during the annual CPT Symposium, which takes place in November. Staff members  from the Ob-gyn Coding Alert and Codify will be reporting directly from the event, so look to future issues of this publication for further information and instruction.

Brace For New Observation, Flu Additions

The biggest news? CPT adds to your E/M coding options with the introduction of three new observation codes, as follows:

• 99224 -- Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval  history; Problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/ or family's needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 15 minutes at the bedside and on the patient's hospital floor or unit.
• 99225 -- Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 25 minutes at the bedside and on the patient's hospital floor or unit.
• 99226 -- Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Physicians typically spend 35 minutes at the bedside and on the patient's hospital floor or unit.

It isn't yet clear how CPT will instruct you to bill the subsequent observation codes, but the CPT Symposium should clarify this.

Flu: On the other hand, no clarification should be required for the new pandemic formulation flu vaccine codes. Your CPT 2011 book will feature 90664-90668 (Influenza virus vaccine, pandemic formulation ...), codes that went into effect July 1, 2010 (following the six month implementation period which began Jan. 1, 2010).

Remember: Use these codes not for the regular flu, but for widespread illness, says Carol Pohlig, BSN, RN,CPC, ACS, senior coding and education specialist at the University of Pennsylvania Department of Medicine in Philadelphia. The new codes were created to reflect vaccines that "differ in both formulation and cost, which requires differentiation of products," Pohlig says.

Sort through Radiation Implant News

Among the list of brand new codes are radiation implant codes that may or may not impact your ob-gyn practice. They are:

• 38900 -- Intraoperative identification (e.g., mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure)
• 49327 -- Laparoscopy, surgical; with placement of interstitial device(s) for radiation therapy guidance (e.g., fiducial markers, dosimeter), intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple (List separately in addition to code for primary procedure)
• 49412 -- Placement of interstitial device(s) for radiation therapy guidance (e.g., fiducial markers, dosimeter), open, intra-abdominal, intrapelvic, and/or retroperitoneum, including image guidance, if performed, single or multiple (List separately in addition to code for primary procedure)
• 49418 -- Insertion of tunneled intraperitoneal catheter (e.g., dialysis, intraperitoneal chemotherapy instillation, management of ascites), complete procedure, including imaging guidance, catheter placement, contrast injection when performed, and radiological supervision and interpretation, percutaneous
• 57156 -- Insertion of a vaginal radiation afterloading apparatus for clinical brachytherapy

"While we do not yet know the rationale behind all of these additions, the new code 57156 should be good news for gyn oncologists who are separately inserting a vaginal device for the later application of brachytherapy as part of endometrial cancer treatment," says Melanie Witt, RN, CPC, COBGC, MA, an independent ob-gyn consultant from Guadalupita, NM. We will have to wait until the presentation at the symposium, however, to know the details of the work involved, she adds.

Prepare for Cat II, III Changes

Also, CPT 2011 will feature new Category II and Category III codes that may affect your practice.

Category III: If your ob-gyn performs an anoscopy, you should add 00226T (Anoscopy, high resolution [HRA] [with magnification and chemical agent enhancement]; diagnostic, including collection of specimen[s] by brushing or washing when performed) and 0027T (... with biopsy[ies]) to your coding arsenal. Remember: Category III codes are temporary codes for emerging technology, services, and procedures that allow the Centers for Medicare and Medicaid Services (CMS) to collect data on the use of these new services - an ability unlisted codes do not possess. If a Category III code for a service exists, you must report the Category III code and not an unlisted Category I (CPT) code.

Category II: Category II codes help better describe E/Ms and can correlate a patient's condition to the treatment rendered, says Denae M. Merrill, CPC, coder for Covenant MSO in Saginaw,  Mich. You've got five new F codes to use:

• 3008F -- Body Mass Index (BMI), documented (PV)
• 3015F -- Cervical cancer screening results documented and reviewed (PV)
• 3294F -- Group B Streptococcus (GBS) screening documented as performed during week 35-37 gestation (Pre-Cr)
• 4004F -- Patient screened for tobacco use AND received tobacco cessation counseling, if identified as a tobacco user (PV)
• 4340F -- Counseling for women of childbearing potential with epilepsy (EPI)

Category II codes are the denominator in PQRI reporting, so it's in your best interest to use them. What About Deletions? As for deletions, you have only two -- which CPT replaces with other codes.

SUI treatment: CPT 2011 deletes 0193T (Transurethral, radiofrequency micro-remodeling of the female bladder neck and proximal urethra for stress urinary incontinence) but adds 53860 (Transurethral radiofrequency micro-remodeling of the female bladder neck and proximal urethra for stress urinary incontinence) in its place.

Chemotherapy: You should also strike out 96445 (Chemotherapy administration into peritoneal cavity, requiring and including peritoneocentesis) but add 96446 (Chemotherapy administration into the peritoneal cavity via indwelling port or catheter) in its place. "This is clinically more accurate as to how physicians do this," Witt says.