Ob-Gyn Coding Alert

If you’re using patient portals, you’ll rejoice at the inclusion of these new online codes.

You’ll find a total of 394 code changes in the 2020 CPT^® code set, including 248 new codes, 71 deletions, and 75 revisions — but not to worry. We’ve broken down which codes affect your ob-gyn practice the most, so you can start learning them now. 

Highlights: Of these new ob-gyn additions, “I like the new T codes for the fallopian tube implants and the hystero-salpingo-contrast sonography (HyCoSy) the best,” says Melanie Witt, RN, MA, an ob-gyn coding expert based in Guadalupita, N.M. See below.

CPT^® Gets Hip to the Times

As of Jan. 1, 2020, you’ll say goodbye to 99444 (Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network).

Instead, you’ll report this service using the following new options:

• 99421 (Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes),
• 99422 (… 11-20 minutes), and
• 99423 (… 21 or more minutes).

You’ll find similar codes for qualified nonphysician health care professionals (see new CPT^® codes 98970-98972, replacing 98969).

These codes reflect “this year’s important additions to CPT^®.” They came about because of “novel digital communication tools, such as patient portals, that allow health care professionals to more efficiently connect with patients at home and exchange information,” according to the AMA press release entitled “AMA Releases 2020 CPT® code set” (URL:  www.ama-assn.org/press-center/press-releases/ama-releases-2020-cpt-code-set?fbclid=IwAR0F0v6UWRTVfYT-MCZGrbZekKa3sEA6hx75PzG1Iw2hDn7tRrQOLlqNnxo).

Say Goodbye to 90911 and Put Timed Codes in Its Place

After January 1, you should strike off 90911 (Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry) from your urogynecology coding options.

Instead, you’ll report 90912 (Biofeedback training, perineal muscles, anorectal Or urethral sphincter, including EMG and/or ranometry, when performed; initial 15 minutes of one-on-one physician or other qualified health care professional contact with the patient) and 90913 (… each additional 15 minutes of one-on-one physician or other qualified health care professional contact with the patient) based on the service’s time.

So, if the urogynecologist spends 23 minutes with the patient performing biofeedback training, then you would report both 90912 and 90913.

Don’t Forget About the New Flu Vaccine Code

As with every year, you’ll find a new flu vaccine code: 90694 (Influenza virus vaccine, quadrivalent (allV4), inactivated, adjuvanted, preservative free, 0.5 mL dosage, for intramuscular use). This code will be in your 2020 CPT^® manual, and while the implementation date was July 1, 2019 most payers, including Medicare, have not yet added the code to approved flu vaccines.

Currently, you can find the codes available for flu vaccines in this MLN Matters Document:  https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE19022.pdf, as noted by Lori Carlin, CPC, COC, CPCO, CCS, director of professional coding services at Pinnacle Integrated Coding Solutions.

Note: This chart is located in this MLN Matters Document:  https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE19022.pdf.

You’ll Be Using This New Cat III Code A Lot

You can delete Category III codes 0357T (Cryopreservation; immature oocyte[s]) and 0377T (Anoscopy with directed submucosal injection of bulking agent for fecal incontinence). You won’t find any regular CPT^® codes to replace them.

However, you have a handful of new Category III codes to learn. They are:

• 0548T (Transperineal periurethral balloon continence device; bilateral placement, including cystoscopy and fluoroscopy)
• 0549T (… unilateral placement, including cystoscopy and fluoroscopy)
• 0550T (… removal, each balloon)
• 0551T (… adjustment of balloon(s) fluid volume) – Note: Do not report 0551T with 0548T, 0549T or 0550T.

Heads up: Codes 0548T-0551T involve the placement of balloons on either side of the urethra and can be used for both female and male incontinence. Currently, the major payers consider the base procedure investigational.

You’ll also see:

• 0567T (Permanent fallopian tube occlusion with degradable biopolymer implant, transcervical approach, including transvaginal ultrasound) — (Do not report 0567T in conjunction with 58340, 58565, 74740, 74742, 76830, 76856, 76857)

Background: At the end of 2018, the company that made the Essure device that is inserted using CPT^® code 58565 removed it from the US market due to concerns about the use metal devices in the fallopian tubes that made lead to migration, fragmentation or tubal perforation. This new T code was proposed based on the use of a degradable implant which is expected to address these concerns, Witt explains. This new code will include transvaginal ultrasound. An because there is now a T code for this procedure, coders should not use 58565 as a proxy, but the work will be similar. Letting the insurer know this is the comparison code may facilitate reimbursement if they previously covered the Essure implants, Witt says.

• 0568T (Introduction of mixture of saline and air for sonosalpingography to confirm occlusion of fallopian tubes, transcervical approach, including transvaginal ultrasound and pelvic ultrasound) — (Do not report 0568T in conjunction with 58340, 74740, 74742, 76830, 76831, 76856, 76857)

You should be using 0568T a lot, Witt says, as this code represents the HyCoSy procedure. This procedure involves both a pelvic gyn ultrasound prior to doing the procedure and transvaginal ultrasound while performing it. This service currently has no exact equivalent in CPT^®. While you have codes for an SIS/HSG (using 58340 with either 76831 or 74740), these code combinations do not accurately address the procedure. With this new T code, you will have a single code that includes the pre-procedure pelvic ultrasound—meaning you cannot report an unlisted procedure code instead. “It should not be too difficult to get reimbursement if the payer already reimburses for an SIS/HSG,” Witt says. “I would use 58340/76831 or 58340/74740 as the comparison codes for the insurer.”

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 submitting 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. 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.