Ob-Gyn Coding Alert

New CPT® manual will feature 186 new codes and 119 deletions, AMA reveals.

Although the 2013 edition of the CPT® Manual is still being printed, the Ob-gyn Coding Alert has had a sneak peek at the codes that you'll use next year -- and uncovered a new code that should help you with your urogynecology services.

Among the changes effective Jan. 1, you'll find 119 deletions, 186 new codes, 263 revisions, and adjustments to 18 CPT® modifiers, the AMA announced in an Aug. 16 article published in its American Medical News.

For example, you'll find a new code for a cystourethroscopy: 52287 (Cystourethroscopy, with injection[s] for chemodenervation of the bladder). Uro-gyns may perform this procedure to treat idiopathic overactive bladder with botulinum toxin that he can't treat in any other way.

Currently, you have to report this with 52000 (Cystourethroscopy [separate procedure]) and 64614 (Chemodenervation of muscle[s]; extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]).

Watch out: Additionally, you'll see new sets of biochemical assay codes for ovarian cancer, type 2 diabetes, and fetal congenital anomalies (81500-81512) -- but your ob-gyn will only order these tests and not perform them. You'll also see the wording change in revisions to various levels (1-9) of molecular pathology testing, but again, your ob-gyn doesn't perform these services.

Don't Miss These Revisions

Speaking of revisions, most of the ob-gyn CPT® 2013 changes you'll need to adopt relate to these type of changes -- not new codes. So if you miss these subtle differences, then you may be setting yourself up for lost reimbursement or a denial. The new wording is underlined, and you'll see the deleted wording via the strikethroughs.

For instance, you'll see that venipuncture code 36410 (Venipuncture, age 3 years or older, necessitating physician'sthe skill of a physician or other qualified health care professional [separate procedure], for diagnostic or therapeutic purposes [not to be used for routine venipuncture]) will include the skill of the physician or other qualified health professional.

You will no longer find a reference to a physician in 59300 (Episiotomy or vaginal repair, by other than attending physician).

You will also find imaging guidance now included with 64561 (Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed). Ob-gyns may perform this on patients with urge incontinence.

You will find an addition to codes 76376 and 76377 (3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation).

CPT® Tweaks E/M Verbiage

Many practices use E/M codes more often than any other code series in CPT®, and you'll find revised descriptors for these codes in 2013.

Whereas most E/M codes previously referred to "physicians" and "providers" in their descriptors, that will change effective Jan.1, when the descriptors will instead say "qualified health care professionals."

Taking 99213 as an example, the code changes are indicated with the strikethroughs (indicating deleted text) and underlining (indicating new text) as follows: "Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other providersqualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spendTypically, 15 minutes are spent face-to-face with the patient and/or family."

What this means: "They are clarifying that all E/M codes can be reported by physicians or other qualified health care providers and changed the wording with regard to time in each of the codes--which really has no bearing on how the codes are used, just that the typical time is spent by all qualified providers who bill these codes," says Melanie Witt, RN, COBGC, MA, an independent coding consultant in Guadalupita, N.M. "In other words, if a payer allows someone other than a physician to provide and bill for a service, the CPT® E/M codes are used by all providers who qualify."

Time assignment: In addition, CPT® will add typical times to the same-day observation or inpatient admission and discharge codes 99235-99236, assigning 50 minutes to 99235 and 55 minutes to 99236. Previously, these codes did not have typical times associated with them, so this change could be helpful to physicians who are at the patient's bedside or on the unit counseling or coordinating care for more than half of the visit, which would allow them to select a code based on time.

Add These Two Transitional Management Codes

In addition, CPT® will introduce two codes under the "transitional care management" heading, which your ob-gyn might report if he provides this level of care after hospital discharge. They are as follows: 

• 99495 -- Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge, Medical decision making of at least moderate complexity during the service period, Face-to-face visit, within 14 calendar days of discharge
• 99496 -- Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge, Medical decision making of high complexity during the service period, Face-to-face visit, within 7 calendar days of discharge

CPT® has not yet released examples of how these new codes will be utilized, and CMS has not assigned RVUs to the new codes yet. However, most coding experts agree that the codes will be used for patients with multiple health conditions who require ongoing care in addition to their E/M and procedural services.