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. Diagnostic Ultrasound 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 [...]