Ob-Gyn Coding Alert

This uterine fibroid ablation approach gets a new code.

This year’s changes to the CPT^® code set includes 230 additions, 49 deletions, and 70 revisions. While only a few changes are for ob-gyn coders, if you don’t learn how to apply them correctly you may find yourself wondering why you received a denial.

Here’s what you can expect, so you can hit the ground running on Jan. 1, 2024.

Keep Your Eye Out for Future Info About +99459

The first addition for ob-gyn is significant, but experts aren’t certain of the rationale.

You will have +99459 (Pelvic examination [List separately in addition to code for primary procedure]) as of January 1. According to the CPT^® Editorial Panel Meeting Minutes from September 2022, this new code will be valued for practice expense only.

“As the new code indicates, it is an add-on code, which you can only bill with another service,” says Melania Witt, RN, MA, an independent coding expert based in Guadalupita, New Mexico. “However, it is not clear what that means. Maybe they can bill with the preventive services or maybe it is just for problem E/M [evaluation and management] services. I think we need to see the CPT^® changes book to see the full explanation. As this is only going to pay practice expense, it almost makes no sense unless the intent is to pay for the collection of the Pap smear specimen.”

Stay tuned to the Ob-gyn Coding Alert for more information.

Update This Uterine Ablation Procedure

Another minor change involves CPT^® moving 0404T (Transcervical uterine fibroid(s) ablation with ultrasound guidance, radiofrequency) from its current, temporary Category III code status to permanent Category I status. The change brings about a new code, 58580 (Transcervical ablation of uterine fibroid(s), including intraoperative ultrasound guidance and monitoring, radiofrequency), which you will begin using in January 2024 when 0404T will be deleted.

History: Radiofrequency ablation can be applied using the laparoscopic or transcervical approach. In general, the procedures involve the insertion of probes multiple times into the fibroid. When activated, the various energy sources induce devascularization and ultimately ablation of the target tissue.

“We already have a code for laparoscopic approach: 58674, which was added to CPT^® in 2017; now, we have the other approach,” Witt says. “I looked up coverage rules by several carriers and they all said this would be covered if the patient met the following criteria:

• “Uterine preservation is desired; and
• “Fibroids are less than 10 cm in any diameter; and
• “Uterine size does not exceed 16 weeks’ gestation.”

Make Note of These Small E/M Time Changes

After the extensive changes CPT^® made to the E/M codes and guidelines over the last few years, you’ll be relieved to know that this year’s E/M changes are minimal. For 2024, CPT^® has decided to remove the time ranges from both the new and established office/outpatient E/M codes and replace them with a single total time amount, which is the lowest number of minutes in the current range for each code. This time “must be met or exceeded,” according to the new wording that appears in each of the codes’ descriptors.

For example, 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/ or examination and straightforward medical decision making …) has a current time range of 15-29 minutes. However, beginning Jan. 1, 2024, the provider must meet or exceed 15 minutes of total service time on the date of the encounter for time-based coding, as indicated by the new code descriptor (emphasis added): (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.).

In table form, the changes look like this:

Essentially, “this doesn’t really change how the codes are used, but listing the minimum time instead of a range for each code is probably going to be easier to follow,” says Kelly Loya, CPC, CHC, CPhT, CRMA, CHIAP, associate partner at Pinnacle Enterprise Risk Consulting Services.

What will happen to G2212? One possible result of this change may be the resolution to the dispute between CPT^® and Medicare over the prolonged service threshold times. Basically stated, Medicare created their own code, G2212 (Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure …), as AMA/CPT^® viewed prolonged services as beginning at the minimum time for 99205 and 99215 and CMS beyond the maximum. Now that the time ranges for 99205/99215 have been replaced by a threshold at the minimum end of the range, it is possible that Medicare may follow CPT^® rules and adopt +99417 (Prolonged outpatient evaluation and management service(s) time … each 15 minutes of total time …) for prolonged services instead.

CPT^® has also made one other slight change. This change applies to the nursing facility care codes 99306 (Initial nursing facility care, per day, for the evaluation and management of a patient …) and 99307 (Subsequent nursing facility care …), raising their time thresholds by five minutes to 50 and 20 minutes, respectively. “It will be important for [clinicians] to know these new, higher thresholds if they are seeing patients in a nursing facility,” Loya notes.