Ob-Gyn Coding Alert

CPT 2003 includes many changes for ob-gyn coders, but these have been long-awaited and should make communication between the physician and insurer easier regarding the type and difficulty for many procedures they routinely perform.

Although this article presents codes and editorial changes that will be used predominately by ob-gyn practices, you should review the CPT 2003 manual and all changes to ensure that you capture any changes for specialty services or common reporting practices. For example, CPT 2003 has deleted the optional five-digit modifier codes (e.g., 09925). This change is necessary because the uniform electronic claim set up as a result of HIPAA regulations can only accommodate a two-character modifier, says Melanie Witt, RN, CPC, MA, an independent coding consultant and educator based in Fredericksburg, Va.

Possibly the biggest and most welcome change in CPT codes for 2003 is represented in the obstetric ultrasound section. "These codes have been totally revamped to allow maternal fetal specialists to accurately report the ultrasound procedures they perform," Witt says. A new note now precedes this section and gives a clear definition of the work that would be included in each code. For instance, the note states that "Codes 76801and 76802 include determination of the number of gestational sacs and fetuses, gestational sac/fetal measurements appropriate for gestation (<14 weeks 0 days), survey of visible fetal and placental anatomic structure, qualitative assessment of amniotic fluid volume/gestational sac shape and examination of the maternal uterus and adnexa." Coders should spend some time reviewing this section to ensure correct billing.

76801 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (<14 weeks 0 days), transabdominal approach; single or first gestation

76802 each additional gestation (list separately in addition to code for primary procedure performed) (Use 76802 in conjunction with 76801.)

76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or =14 weeks 0 days), transabdominal approach; single or first gestation

76810 each additional gestation (list separately in addition to code for primary procedure performed) (Use 76810 in conjunction with code 76805.)

76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation

76812 each additional gestation (list separately in addition to code for primary procedure performed) (Use 76812 in conjunction with code 76811.)

76815 Ultrasound, pregnant uterus, real time with image documentation, limited (e.g., fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), one or more fetuses (Use 76815 only once per exam and not per element.)

76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up (e.g., re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system[s] suspected or confirmed to be abnormal on a previous scan), transab-dominal approach, per fetus (Report 76816 with modifier -59 for each additional fetus examined in a multiple pregnancy.)

76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal. (For non-obstetrical transvaginal ultrasound, use 76830.) (If transvaginal examination is done in addition to transabdominal obstetrical ultrasound exam, use 76817 in addition to appropriate transabdominal exam code.)

"It is great to finally get some more definitive codes for ultrasound," says Penny Schraufnagel, office manager for Ob-Gyn Center PA in Boise, Idaho. "Having the multiple gestation scans spelled out will give us greater clout with the insurers that have tried to bundle multiple scans into one with multiple babies." Also, having the code descriptors address specifically what each type of ultrasound will cover will make coding decisions much easier, Schraufnagel says, especially the differences between 76815 and 76816.

"Adding 76817 will also make it easier to differentiate transvaginal obstetric exams from gynecological exams," she notes.

There also has been a change in CPT instructions for coding multiple fetuses when performing a fetal biophysical profile (BPP). In previous versions of CPT, coders were instructed to use modifier -51 (Multiple procedures) for the second or third BPP. For 2003, CPT indicates that the second and any additional fetuses should be reported separately by appending modifier -59 (Distinct procedure service) to report 76818 (Fetal biophysical profile; with non-stress testing) or 76819 ( without non-stress testing). "BPP coding changes will eliminate any questions as to number and content of exams," Schraufnagel says.

"Coders should also note that CPT 2003 explicitly states that if the ob-gyn performs a transvaginal examination in addition to transabdominal gyn ultrasound exam, you should report 76830 (Ultrasound, transvaginal) in addition to transabdominal exam code (76856-76857)," Witt maintains. "You will still have to use a modifier -51 for the second scan in all likelihood and some payers may still deny the second charge, but with CPT guidelines to follow, it may be easier to appeal any denials."

For those practices that perform CAT bone density studies, there is a revision in terminology in one code and the addition of a second code to differentiate between studies done on the axial skeleton and one done on the peripheral skeleton.

76070 Computed tomography, bone mineral density study, one or more sites; axial skeleton (e.g., hips, pelvis, spine)

76071 appendicular skeleton (peripheral) (e.g., radius, wrist, heel).

CPT 2003 has revised the Pap smear codes to more clearly represent current screening and rescreening techniques. You should note that two new codes have been added, but codes 88144 and 88145, which described "thin prep" manual screening and computer-assisted rescreening, have been deleted.

88174 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision

88175 with screening by automated system and manual rescreening, under physician supervision. (For manual screening, see 88142 and 88143.)

CPT has added a new code for 2003 (89055, Leukocyte count, fecal) to describe laboratory testing for fecal leukocytes. This code will replace the HCPCS Level II G0026 (Fecal leukocyte examination). Code 89310 (Semen analysis; motility and count [not including Huhner test]) has been revised to specifically exclude Huhner testing, and it will replace G0027 (Semen analysis; presence and/or motility of sperm excluding Huhner test).

CPT has added several new Category III codes in 2003 that ob-gyns will likely use. CPT's Category III codes represent new emerging technology, and payers may not necessarily reimburse for them. "When a Category III code exists that accurately describes the procedure or service performed by the ob-gyn, you must report that code rather than an unlisted code," Witt says. CPT adds Category III codes to its database in January and July. To check on any new Category III codes before the yearly CPT edition is published, go to http://www.ama-assn.org/ama/pub/article/3885-4897.html.

Code 0028T (Dual energy x-ray absorptiometry [DEXA] body composition study, one or more sites) represents the procedure to assess body fat composition. "Although the procedure is popular with athletes, insurers probably will not cover it in many cases," Witt cautions. Generally, medical indications for this procedure include children with growth disorders, patients with eating disorders, patient with rapid intervention or unintentional weight loss, patients on long-term total parenteral nutrition, and adults with growth hormone deficiency.

In 2003, you will use 0029T (Treatment[s] for incontinence, pulsed magnetic neuromodulation, per day) to report treatment with the NeoControl system. Basically, the patient sits in a chair that induces contractions in the muscles of the pelvic floor and urinary sphincters via a pulsed magnetic field.

The new 0030T (Antiprothrombin [phospholipid cofactor] antibody, each Ig class) represents an antibody test to assess patients who may be at risk for, among other things, fetal loss.

The codes 0031T (Speculoscopy) and 0032T ( with directed sampling) have been added to report a procedure that uses light to examine the cervix and aid in specimen collection when the physician must identify abnormal lesions. You should use these codes to report PapSure.