Ob-Gyn Coding Alert

Again, you need to update how you report flu vaccines.

Although CPT® 2018 doesn't bring a massive overhaul to ob-gyn codes, you still have to learn some subtle changes that could have a big impact to your bottom line. Check out how you'll need to learn one code, discard another code, update your flu vaccines yet again, revisit Category III codes, and make some revisions.

1. Zero In on This Single New Ob-Gyn CPT^® Code

Although you'll find a lot of new CPT^® codes for 2018, you will only find one specific ob-gyn code, which is 58575 (Laparoscopy, surgical, total hysterectomy for resection of malignancy [tumor debulking], with omentectomy including salpingo-oophorectomy, unilateral or bilateral, when performed).

"Although we will learn more at the AMA meeting, I can guess CPT^® included this code because this type of surgery is being done laparoscopically, so it is the equivalent to the open procedure (58953, Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking)," says Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico. "Normally this type of surgery with debulking would be done for advanced ovarian cancer."

2. Update Your Flu Vaccine Coding

You'll need to update your flu vaccine coding, as of January 1. You will have 2 new flu vaccines and a Zoster vaccine (for shingles). They are:

3. Don't Miss These Category III Codes

You will also have some Category III codes to learn.

Remember, when a Category III code exists to describe a service or procedure, you must use that Category III code - rather than an unlisted-procedure code - to describe the service when placing a claim. So, why is this important?

Use category III codes for new procedures:  Category III CPT^® codes are temporary codes. "The need for these codes [arose] due to the development of new technology," says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the Hospital of the University of Pennsylvania. "It may be a while before this service is rendered effective and covered."

The primary purpose of these codes is to allow for data collection, which in turn provides information for evaluating the effectiveness of new technologies and the formation of public and private policy. In other words,

Category III codes are preferred by insurers and policy makers: Category III codes give insurers and government policy makers a way to track the effectiveness and rate-of-use of as-yet-unproven technologies, which could affect future coverage decisions. Such data collection is not possible with unlisted-procedure codes.

First step to category I CPT^® code: The designation of a Category III code is an important first step in wider adoption of new technology and the eventual creation of a Category I CPT^® code to describe the service (although this doesn't happen in every case).

Long-term promise: Generally, a Category III code will be archived after five years unless the AMA creates a Category I code for the service prior to that time.   

These are the Category III codes that will potentially impact your practice:

4. Don't Overlook These Revisions

You will have to look closely to notice, but the preamble to the "Initial Observation Care, New and Established Patient" section of CPT^® and the full code descriptors for 99217-99220 have the words "outpatient hospital" inserted before the term "observation status." For example, the passage now reads as follows:

"The following codes are used to report the encounter(s) by the supervising physician or other qualified health care professional with the patient when designated as outpatient hospital 'observation status.'"

Translation: This appears to indicate observation services areonly allowed in the hospital setting, whereas the presumption in the past was that observation was a "status" and not a defined place. That status is now limited to the outpatient hospital setting. This should not be a concern for hospital-based EDs, but it could be a concern for freestandingemergency centers if they are deemed not to be outpatient hospitals.

Additionally, you should highlight the following revisions:

"Again, we will need to wait until the AMA meeting to know the rationale for certain, but most physicians have been routinely performing a diagnostic cystoscopy (52000, Cystourethroscopy [separate procedure]) when doing repairs of the vaginal wall prolapse," Witt says. "Usually, there has been no evidence in the documentation that this is done for a reason other than checking to be sure no harm was done to the bladder during the procedure. Therefore, we can assume that the Editorial Panel decided that it was time to let physicians know that this cystoscopy should be considered an integral part of the procedure, when performed."

5. Strike 88154 Off Your List

Finally, you have one deletion to note. After October 1, you should no longer report 88154 (Cytopathology, slides, cervical or vaginal; with manual screening and computer-assisted rescreening using cell selection and review under physician supervision).