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Ob-Gyn Coding Alert

Don't Overlook New Lab and Category III Codes

Published on Sat Jan 01, 2005

Get ready to use 84163 for PAPP-A screening tests

Fibroid ablation techniques sound complicated, but you'll find coding uncomplicated now that you've got 0071T-0072T to use. Keep these and other Category III codes fresh in your mind, and your winter is sure to pass smoothly.
 
Rule: "If a Category III code exists for your procedure, you must use it," says Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting in Denver.  "You may not revert back to an unlisted-procedure code unless a private payer instructs you to do so in writing."

0071T, 0072T Simplify Fibroid Ablation

The new technique for fibroid ablation remains in clinical trials, but CPT has designated codes for it.  Most practitioners agree that hysterectomy and various myomectomy procedures are considered the gold-standard treatment for uterine fibroids. Lately, research has focused on developing minimally invasive alternatives, which include endometrial ablation, various laparoscopic ablative procedures using differing energy sources (such as laser, radiofrequency ablation, or cryotherapy), and uterine artery embolization, says Melanie Witt, RN, CPC, MA, an independent coding consultant in Fredericksburg, Va.
 
"Most recently, there have been clinical trials using high-intensity focused ultrasound treatment that is guided by magnetic resonance imaging (MRI). This treatment is a totally noninvasive approach to the ablation of uterine fibroids," Witt says.
 
What happens: The ultrasound beam penetrates through the soft tissues and, using MRI for guidance and monitoring, the ob-gyn can focus the beam on targeted sites. The ultrasound causes a local increase in temperature in the target tissue, resulting in coagulation necrosis while sparing the surrounding normal structures.
 
The associated MRI imaging can also provide on-line thermometric imaging that displays a temperature "map." Ob-gyns can use this map to confirm the therapeutic effect of the ablation treatment and allow for real-time adjustment of the treatment parameters.
 
CPT describes this cutting-edge procedure using two new codes:
 

  • 0071T - Focused ultrasound ablation of uterine leiomyomata, including MR guidance; total leiomyomata volume less than 200 cc of tissue
     
  • 0072T - ... total leiomyomata volume greater than or equal to 200 cc of tissue.

    Heads-up: Just because these codes reach the CPT book on Jan. 1 doesn't mean you shouldn't be using them now. CPT put 0071T and 0072T into effect as of July 1. "Because Category III codes are new-technology codes, the American Medical Association (AMA) felt that release of the codes was required so that data could be accumulated as soon as possible to ensure these temporary codes could be converted to Category I CPT codes in a timely fashion," Witt says.
     
    Tip: You should check the AMA Web site every January and July to check for any new Category III codes: www.ama-assn.org/ama/pub/category/3885.html.

    Don't Be Last to Report 0074T

    You should already be using 0074T (Online evaluation and management service, per encounter, provided by a physician, using the Internet or similar electronic communications network, in response to a patient's request, established patient) for an online medical evaluation, because it became active on July 1, 2004.

    The notes describing an online medical evaluation (0074T) state that the "reportable services involve the physician's personal timely response to the patient's inquiry and must involve permanent storage (electronic or hard copy) of the encounter." Keep in mind that a reportable service encompasses the sum of communication pertaining to the online patient encounter or problems, according to the AMA.

    Use 0087T for Sperm Evaluation

    The sperm evaluation test developed by PA-Biocoat is based on the presumption that sperm that bind to HA are mature and can fertilize an ovum, while those that do not are immature and less likely to be able to fertilize the egg.  "Code 0087T (Sperm evaluation, Hyaluronan binding assay) is a predictor of successful artificial reproductive techniques and can pinpoint a problem with the male sperm, which may lead to effective treatment," Witt says. The start date for this code is Jan. 1.

    Take Note of 2 Lab Changes

    If you've searched for a code for pregnancy-associated plasma (PAPP-A), search no more. This year, there are only two code changes of note in the laboratory section of CPT - one of which inducts the code for PAPP-A into the ranks of lab codes.

    First, CPT added 84163 (Pregnancy-associated plasma protein-A [PAPP-A]). Ob-gyns use this screening test to identify women at highest risk of carrying a fetus with Down's syndrome, trisomy 18, or other chromosomal abnormalities.
      
    Second, CPT revised the existing code 89346 (Storage [per year]; oocyte) by making the word "oocyte" plural.  This means that this code is reported once regardless of the number oocytes being stored.

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