Ob-Gyn Coding Alert

To support CPT notation, NCCI bundles 58555 and 57800 with 58565

If you've just now got a handle on ob-gyn's new 2005 CPT codes, you may find that your work is only half done - thanks to the extensive National Correct Coding Initiative (NCCI) edits that kicked off the new year. NCCI's primary changes involve the new CPT 2005 codes and three familiar ones - the new add-on code for mesh insertion (57267) as well as the Doppler velocimetry codes (76820 and 76821). Replace Old 57282/57280 Edit

In the past, you would have had to provide documentation and append modifier -59 (Distinct procedural service) to bypass the edit that included 57282 (Sacrospinous ligament fixation for prolapse of vagina) into the work represented for 57280 (Colpopexy, abdominal approach), thanks to NCCI 10.3.

Remember: The CPT 2005 descriptor for 57282 is Colpopexy, vaginal; extra-peritoneal approach (sacrospinous, iliococcygeus).

But NCCI version 11.0 is here to change all that. This version deletes this edit but replaces it with a new one. Now 57282 permanently includes 57280. "In other words, you'll never be reimbursed if you report an abdominal colpopexy with an extra-peritoneal colpopexy," says Melanie Witt, RN, CPC, MA, an independent coding consulting in Fredericksburg, Va. This edit has a modifier indicator of "0," which means you cannot use a modifier to separate these services.

Master Modifiers for Separate IV Infusions

You should keep in mind that NCCI removed code 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) from all ob-gyn code edits.

But don't assume that Medicare will allow you to report IV infusions with surgical infusions. In fact, Medicare has substituted the new IV infusion codes (G0345, Intravenous infusion, hydration; initial, up to one hour; and G0347, Intravenous  infusion, for therapeutic/diagnostic; initial, up to one hour) as edits into all of the ob-gyn CPT codes. While you can use modifier -59 to bypass the edit, your ob-gyn will have to show that the IV infusion was not an integral part of the surgical procedure.

Avoid Using E/M Codes and G0344

As of Jan. 1, you should be reporting the new "Welcome to Medicare" exam implemented by Congress with code G0344 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first six months of Medicare enrollment). 

NCCI 11.0 edits bundle a slew of E/M codes into G0344, including new outpatient services (99201-99205), established outpatient services (99211-99215), outpatient consultations (99241-99245), confirmatory consultations (99271-99275), and emergency department services (99281-99285). 
 
Note: "We are not doing the welcome-to-Medicare exams, but from what I have read, we can code the screening pelvic and breast exam (G0101) and obtaining Pap (Q0091) separately," says Penny Schraufnagel, office manager for Ob-Gyn Center PA in Boise, [...]