Ob-Gyn Coding Alert

Here’s what the new symbol in your CPT^® manual means.

You’ve likely been preparing for the E/M transformation about to hit as of January 1, 2021 — but if you’re overlooking the other subtle changes, you could be setting up your claims for disaster. Make 2021 the best year ever by learning and adapting to these five changes as soon as possible.

1. Adapt to the Major E/M Codes

Starting on Jan. 1, 2021, you will see major changes to the evaluation and management (E/M) patient office codes, as outlined by the 2020 Medicare Physician Fee Schedule Final Rule (MPFS). Among the most drastic of these changes is the newfound attention you will put on medical decision making (MDM) and time in your ob-gyn’s medical documentation. You’ll delete 99201 (Office or other outpatient visit …) and choose from 99202-99215 instead.

Note: You’ll see a new symbol (a 5 point star) to denote you can bill these codes as a telehealth service (as in, all office E/M services except 99211), says Melanie Witt, RN, MA, an independent coding expert based in Guadalupita, New Mexico. Appendix P will also list all telehealth codes.

More info: Check out in-depth Ob-Gyn Coding Alert articles “Part 1: Nix 99201 From Your New Patient Office E/M Codes in 2021” (volume 23, number 3), “Part 2: Determine How Established Office E/M Codes Will Change in 2021” (volume 23, number 7), and “Part 3: Manage Your MDM Component Expectations When 2021 Hits” (volume 23, number 10) for more information.

2. Prepare To Use New Prolonged Services

You will also need to learn about new prolonged services codes.

Note that +99354 (Prolonged service(s) in the outpatient setting requiring direct patient contact beyond the time of the usual service; first hour (List separately in addition to code for outpatient Evaluation and Management or psychotherapy service, except with office or other outpatient services [99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215])) and +99355 (… each additional 30 minutes (List separately in addition to code for prolonged service)) are add-on codes that you cannot report with 99202-99205 or 99212-99215.

However, you can use +99415 (Prolonged clinical staff service (the service beyond the highest time in the range of total time of the service) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (List separately in addition to code for outpatient Evaluation and Management service)) and +99416 (… each additional 30 minutes (List separately in addition to code for prolonged service) with 99202-99205 and 99212-99215.

You also have new code +99417 (Prolonged office or other outpatient evaluation and management service(s) beyond the minimum required time of the primary procedure which has been selected using total time, requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service, each 15 minutes of total time (List separately in addition to codes 99205, 99215 for office or other outpatient Evaluation and Management services)).

Is your ob-gyn doing rounds? You could also reporting +99356 (Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour (List separately in addition to code for inpatient or observation Evaluation and Management service)).

Heads up: You will see other revised codes for chronic and complex care management, but you can breathe a sigh of relief. Your ob-gyn probably won’t need these codes. Primary care practices who deal with multiple chronic diseases will be the ones who use them.

3. Update These Breast Codes

Revised breast codes 11970-19380 include just more medically appropriate language, but the substance of the codes has not changed, Witt says. For instance, code 19325 will change from “Mammaplasty, augmentation with prosthetic implant” to “Breast augmentation with implant.” So if your surgical ob-gyn performs these procedures, you’ll continue reporting them.

Your ob-gyn will probably not perform computed tomography of the breast, but she may order one. If so, you may need to be aware of the following category III codes:

• 0633T (Computed tomography, breast, including 3D rendering, when performed, unilateral; without contrast material)
• 0634T (… with contrast material(s))
• 0635T (… without contrast, followed by contrast material(s))
• 0636T (Computed tomography, breast, including 3D rendering, when performed, bilateral; without contrast material(s))
• 0637T (… with contrast material(s))
• 0638T (… without contrast, followed by contrast material(s))

4. Low Utilization Gynecology Codes Get the Ax

Deletions: In the gynecology section, codes 57112 (Vaginectomy, complete removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy)) and 58293 (Vaginal hysterectomy, for uterus greater than 250 g; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control) have been deleted. “These may have been deleted because of low utilization,” Witt says. You’ll also delete 76970 (Ultrasound study follow-up (specify)). Again, it may be because it is not used much or is too unspecific and other more specific codes should be used instead.

Addition: CPT^® classifies new code +57465 (Computer-aided mapping of cervix uteri during colposcopy, including optical dynamic spectral imaging and algorithmic quantification of the acetowhitening effect…) as an add-on code. “This is an add-on code to report computer-aided mapping of cervix uteri, during colposcopy,” Witt says.

5. Finally, Take Note of These Lab Codes

You will find a slew of new pathology lab codes, but there are two revisions you should highlight. They are:

• 80415 (Chorionic gonadotropin stimulation panel; estradiol response This panel must include the following: Estradiol, total (82670 x 2 on 3 pooled blood samples))
• 82670 (Estradiol; total), which now includes the “total” work.

New codes: These revisions join new codes:

• 82681 (Estradiol; free, direct measurement (eg, equilibrium dialysis))
• 81513 (Infectious disease, bacterial vaginosis, quantitative real-time amplification of RNA markers for Atopobium vaginae, Gardnerella vaginalis, and Lactobacillus species, utilizing vaginal-fluid specimens, algorithm reported as a positive or negative result for bacterial vaginosis)
• 81514 (Infectious disease, bacterial vaginosis and vaginitis, quantitative real-time amplification of DNA markers for Gardnerella vaginalis, Atopobium vaginae, Megasphaera type 1, Bacterial Vaginosis Associated Bacteria-2 (BVAB-2), and Lactobacillus species (L. crispatus and L. jensenii), utilizing vaginal-fluid specimens, algorithm reported as a positive or negative for high likelihood of bacterial vaginosis, includes separate detection of Trichomonas vaginalis and/or Candida species (C. albicans, C. tropicalis, C. parapsilosis, C. dubliniensis), Candida glabrata, Candida krusei, when reported)

You’ll also have a new code for Human papilloma virus (HPV) – 0096U.

Many of the tests target diagnosis, prognosis, or treatment indications for cancers such as breast (0067U, 0102U, 0129U, +0131U, +0138U) and ovarian (0103U, 0132U).