Ob-Gyn Coding Alert
Don't Get Too Cozy With 2005 Codes - NCCI 11.0 Attacks!
To support CPT notation, NCCI bundles 58555 and 57800 with 58565 Replace Old 57282/57280 Edit You Won't Be Paid for 69990 With 57283 When your ob-gyn performs a vaginal colpopexy using intraperitoneal approach, you should use 57283 (Colpopexy, vaginal; intraperitoneal approach [uterosacral, levator myorrhaphy]) - but before you go any further, you need to make sure you don't inadvertently report it in addition to the edits NCCI 11.0 has created for this service. However, carriers will never reimburse 57283 with an anesthesia code 00940 (Anesthesia for vaginal procedures [including biopsy of labia, vagina, cervix or endometrium]; not otherwise specified). This keeps in line with the rule that Medicare will never pay a surgeon for anesthesia services; only an anesthesiologist can use 00940 in any case, not the operating surgeon, Witt says. Be Wary of Reporting US With 58356 When 58356 (Endometrial cryoablation with ultrasonic guidance, including endometrial curettage, when performed) replaced Category III code 0009T, the new code became fair game for NCCI 11.0 edits. As with 57283, however, you won't receive any reimbursement if you try to report 58356 in conjunction with 00940 or 69990. Can Apply Modifier to 58565/37202 CPT 2005 gave you 58565 (Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants) for the Essure sterilization procedure, and now NCCI 11.0 is giving you more - a slew of edits for this code. However, you'll never get reimbursed for using 58565 in conjunction with anesthesia code 00952, so don't try. Keep in Mind 58956 Is Supracolic As we reported in the January Ob-Gyn Coding Alert, you've got another surgical combination for malignancy in 2005 - code 58956 (Bilateral salpingo-oophorectomy with total omentectomy, total abdominal hysterectomy for malignancy). And now you've got NCCI 11.0 edits galore. Remember: To use 58956, your ob-gyn must document a supracolic omentectomy or, in other words, a total omentectomy.
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).
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, Idaho.
As long as you have the proper documentation to support the use of a modifier, you may be able to bypass the edits that combine 57283 with the following codes:
Furthermore, you won't be able to report 57283 and microsurgery code +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]) either. The modifier indicator of "0" for these two edits prevents you from using a modifier to separate these services.
Don't skip the following edits for 58356 just because you have the slim possibility of reporting a modifier to circumvent it. "In truth, NCCI creates edits to discourage a practice from reporting them, except rarely and in very special circumstances - most of which will never come to pass," Witt says.
First, note that CPT specifically states that you should not report codes 58100 (endometrial sampling), 58120 (D&C), 58340 (catheterization for SIS), 76700 (complete abdominal ultrasound) and 76856 (complete pelvic ultrasound) in addition to 58356. So even though NCCI bundles these codes and offers leeway to report a modifier (as long as you can show that the ultrasound wasn't related to one of these services in question), many payers will still deny it because of CPT's published statement.
The other edits include:
Note: Although not specifically addressed by NCCI, 58356, by definition, includes ultrasound guidance. Be wary of trying to report it with the intraoperative ultrasound guidance code, 76986.
For example: To account for the CPT notation stating that you should not report diagnostic hysteroscopy (58555) and/or dilation of cervix (57800) in addition to 58565, NCCI has applied bundling edits for these codes. If your ob-gyn has proof that these services were distinct, you may be able to bypass that edit with a modifier. But if you don't have that crucial back-up documentation, you shouldn't try to report them separately.
Other components to 58565 now include:
According to version 11.0, you shouldn't report the following services separately from 58956:
Although you may bypass these edits with a modifier and supporting documentation, you'll never bypass the edit that combines microsurgery code 69990 into 58956.
Ob-Gyn Coding Alert
- Don't Get Too Cozy With 2005 Codes - NCCI 11.0 Attacks!
To support CPT notation, NCCI bundles 58555 and 57800 with 58565
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