Ob-Gyn Coding Alert

Say goodbye to circle-with-dot symbol and hello to separate moderate sedation codes.

If you’re used to counting moderate sedation as inclusive to ob-gyn procedures like image-guided fluid collection drainage by catheter, then you need to start dusting off 99152-99153 and 99156-+99157, depending on who performed this service. CPT® 2017 brings you a five changes like these that will impact how you report ob-gyn services starting January 1, 2017, and you can get ahead of your peers by learning them now.

Sources: The AMA has released the almost-final, preproduction version of CPT® 2017. But be aware that you may still see changes to the codes until the AMA officially releases the final version later this fall. Also, you can read about some of the new codes in the 2017 Medicare Physician Fee Schedule (MPFS) proposed rule available at www.federalregister.gov/articles/2016/07/15/2016-16097/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other-revisions.

1. Submit Separate Sedation Code For These Services

CPT® 2017 makes a singular change to hundreds of codes, some of which that ob-gyns might report — remove the moderate sedation “bull’s eye” symbol from the code.

These ob-gyn related codes include:

• 10030 — Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst), soft tissue (eg, extremity, abdominal wall, neck), percutaneous
• 49406 — Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); peritoneal or retroperitoneal, percutaneous
• 49407— … peritoneal or retroperitoneal, transvaginal or transrectal
• 57155 — Insertion of uterine tandem and/or vaginal ovoids for clinical brachytherapy.

What that symbol means: “The bull’s eye means that the procedure includes the moderate sedation service, so you can’t separately report the diagnostic or therapeutic procedure code with a moderate sedation code,” explains Marcella Bucknam, CPC, CPC-I, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, internal audit manager with PeaceHealth in Vancouver, Wash. “For a code that no longer has the bull’s eye symbol [such as those above], you’ll be able to separately report one of the new moderate sedation codes if your surgeon sedates a patient for a procedure that she is performing, or for a procedure that someone else is performing,” she says.

You have new codes to reflect the moderate sedation services, which depends upon who performs them.

Same physician: If performed by the surgeon who is performing the procedure, you should choose either:

• 99152 — Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older
• 99153— … each additional 15 minutes intraservice time (List separately in addition to code for primary service).

You will delete codes 99144 and 99145.

Different physician: If performed by a provider who is not performing the procedure, you should choose from either:

• 99156 — Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient age 5 years or older
• 99157— … each additional 15 minutes intraservice time (List separately in addition to code for primary service).

You will delete codes 99149 and 99150.

Example: Your ob-gyn inserts a uterine tandem for clinical brachytherapy (57155) and another physician performs 25 minutes of sedation. The physician performing the conscious sedation would report 99157. So in this case, the ob-gyn who did the procedure would not bill 99157.

Payment decrease: At the same time as these codes lose the bull’s eye, CMS is proposing to lower the payment to account for the change in how you use the codes (e.g., 57155 has 5.40 work relative value units [RVUs], but they are recommending 5.15 work RVUs for FY 2017). According to the MPFS proposed rule, “we are proposing to maintain current values for the procedure codes less the work RVUs associated with the most frequently reported corresponding moderate sedation code, so that practitioners furnishing the moderate sedation services previously considered to be inherent in the procedure will have no change in overall work RVUs.”

2. Laparoscopic Ablation of Fibroids Gets Regular CPT® Code

If you’re a coding veteran, you may remember CPT® 2013, the year we received 0336T (Laparoscopy, surgical, ablation of uterine fibroid[s], including intraoperative ultrasound guidance and monitoring, radiofrequency). Because clinical research in the U.S. and abroad demonstrated that Radiofrequency Ablation (RFA) was effective in treating fibroids, resolving symptoms associated with more than 80 percent of patients, more physicians were interested in this new technique — hence, the Category III code, which allowed data to be collected on its use.

CPT® 2017 brings the regular Category II code, 58674 (Laparoscopy, surgical, ablation of uterine fibroid[s] including intraoperative ultrasound guidance and monitoring, radiofrequency). You will therefore delete 0336T.

Note: The company that developed this procedure refers to it as “Acessa.”

Payer response: Some commercial payers may still consider Acessa investigational. For instance, Anthem BCBS issued a policy in October 2015 to this effect. They state, “The use of laparoscopic or percutaneous ablation techniques in combination with imaging guidance as a treatment of uterine fibroids is considered investigational and not medically necessary, including but not limited to lasers, bipolar electrodes, interstitial thermotherapy, cryotherapy, and radiofrequency ablation.” (URL: https://www.anthem.com/medicalpolicies/policies/mp_pw_a053391.htm)

Additionally, Aetna reviewed this method in June 2016 and stated that it also was not covered but will review this policy again in March 2017. Aetnaconsiders the following treatments for uterine fibroids experimental and investigational because their safety and effectiveness have not been established:

• Acupuncture
• Cryomyolysis
• Laparoscopic uterine artery occlusion
• Cryotherapy, interstitial thermotherapy, lasers,  electrical, and ultrasound (focused ultrasound) ablation, with or without MRI guidance. (URL: http://www.aetna.com/cpb/medical/data/300_399/0304.html)

However CMS carriers such as Noridian do cover it: “Noridian will provide coverage effective July 1, 2014 for Radiofrequency (RF) ablation only for the treatment of symptomatic uterine fibroids unresponsive to conservative measures when furnished according to FDA-approved indication(s). Compliance with Medicare requirements is subject to review by the Recovery Auditors.” (URL: https://med.noridianmedicare.com/web/jeb/policies/coverage-articles/radiofrequency-ablation-of-uterine-fibroids).

3. Rejoice For Combo CAD, Mammogram Codes

CPT® 2017 adds specific codes for diagnostic and screening mammography. “Computer-Aided Detection (‘CAD’) has become increasingly commonplace …,” says Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, Managing Director of Pinnacle Enterprise Risk Consulting Services (“PERCS”), a division of Pinnacle Healthcare Consulting. “Since coding these two [CAD »»»» and mammogram] radiological images had been separate and typically performed together, the codes were combined to include CAD in the imaging service rendered when it is performed.”

Diagnostic: Depending upon unilateral or bilateral testing, you submit codes 77065 (Diagnostic mammography, including computer-aided detection [CAD] when performed; unilateral) and 77066 (….bilateral) for diagnostic mammography.

Screening: For screening mammography, you will submit code 77067 (Screening mammography, bilateral [2-view study of each breast], including computer-aided detection [CAD] when performed).

Strike off these mammography codes: The following mammography codes will be deleted:

• 77051, Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further review for interpretation, with or without digitization of film radiographic images; diagnostic mammography (List separately in addition to code for primary procedure)
• 77052, Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further review for interpretation, with or without digitization of film radiographic images; screening mammography (List separately in addition to code for primary procedure)
• 77055, Mammography; unilateral
• 77056, Mammography; bilateral
• 77057, Screening mammography, bilateral (2-view study of each breast).

4. Underline Dosage, and not Age, for New Flu Codes

CPT® 2017 revises the flu codes to delete any reference to the patient’s age. Instead, you should report them based on the dosage the ob-gyn administers. See below:

5. Finally, Delete this Category III Code

As of January 1, you will no longer need to worry about reporting 0288T (Anoscopy, with delivery of thermal energy to the muscle of the anal canal [e.g., for fecal incontinence]). CPT® 2007 will delete this code, and you won’t have a regular CPT® code to replace it.