Ob-Gyn Coding Alert

If theres no appropriate laparoscopic procedure code available, many ob-gyn coders make the mistake of thinking that its okay to use the CPT code for the open approach when the procedure is actually performed laparoscopically. For example, coders think that when a laparoscopic Burch is performed, a procedure which reduces urinary incontinence following childbirth, they can use 51840 (anterior vesicourethropexy, or urethropexy; [e.g., Marshall-Marchetti-Krantz, Burch]; simple). But unless the procedure is done via the open approach, in which the physician cuts through the abdomen, the correct code is 56399 (unlisted procedure, laparoscopy, hysteroscopy).

In other words, just because something can be done by laparoscope doesnt mean theres a specific code for it.

Unlisted Laparoscopy Code Only Option

If a doctor is performing a procedure that has a CPT code that only describes the open procedure, but is doing it as a laparoscopic procedure, the doctor has to use the unlisted laparoscopy procedure code, explains Melanie Witt, RN, CPC, MA, program manager for the department of coding and nomenclature for the American College of Obstetricians and Gynecologists (ACOG). There is a CPT code for Burch, but it only describes the open approach, adds Witt. You cant use that code for the procedure done laparoscopically.

Tip: In next years CPT 2000, there will be a laparoscopic code for Burch. And it will be right next to the open one; the laparoscopic codes will be scattered throughout the CPT manual, instead of all in one place the way they are now.

Many procedures can be either open or laparoscopic, says Carolyn Roberts, CCS, CCS-P, CPC, coding and reimbursement analyst specializing in ob-gyn for the Springfield, MA-based Bay State Medical Education and Research Foundation, where she bills for about 50 ob-gyns. If a CPT code is available for the open approach, it is very tempting for the coder to use the open procedure code, she adds. Thats because theres a lot more work involved with using the unlisted code. With the open codeeven if its wrongit seems easier to use it. You usually get paid faster, says Roberts. But its incorrect, and later if the carrier discovers they paid an incorrect code, you might have to pay them back, or you may even be fined.

Roberts admits that unlisted codes are a pain. We get denials when we use them, she relates. But thats the insurance companys fault. When she appeals, she gets paid. If no specific code exists for what you did, you cant just go to the open code, Roberts reiterates. You have to use the unlisted code.

If we report a laparoscopic procedure as an open one, then the data is being used to compare clinical outcomes, average length of stay for hospitals, and even to negotiate future managed care contracts, Roberts cautions.

Amy Blum, RRA, medical classifications specialist for the National Center for Health Statistics, agrees. Surgical approaches are not coded for ICD-9, which is what Blum, an ob-gyn specialist, works on. But it is important to use the most specific code possibleand the most accurate. If theres a procedure and no code for it, you should always use the unlisted code, Roberts says.

Tip: Blum notes there is a V code for a procedure that starts as a laparoscopy and is converted to open: V64.4. Its important for this code to be used when applicable, for both the ob-gyn and for hospital billing.

Protect Yourself, Get It In Writing

There is a postscript to the argument that you must use 56399 for laparoscopic procedures done when there is no laparoscopic procedure code. This is what happens when the insurance company decides that if there is no code, it wont pay. These insurance companies simply refuse to deal with unlisted procedure codes and the extra paperwork they entail.

Lets say you are coding a laparoscopic Burch, using 56399 as you should. It is denied. To appeal, you contact the provider relations person at the insurance company. Your carrier informs you that you should have used 51840 (anterior vesicourethropexy or urethropexy [e.g., Marshall-Marchetti-Krantz, Burch]; simple). And, even though you inform them that it is incorrect coding, they dont care. They want you to file it as a 51840 in order to process and pay the claim.

Do not file that claim as a 51840 unless you get something in writing from the carrier telling you to do so, warns ACOGs Witt. Otherwise, if you get audited, you might have to pay fines down the road. Lets say a new managed care company buys the one you are dealing with, but the new company doesnt have the same policy of using 51840 when the procedure should actually be coded as an unlisted laparoscopic code. If the new company audits your practice, all of your laparoscopic procedures will be found to be miscoded. That is not a position you want to be in.

Tip: Most insurance companies dont mind giving you the direction in writing to file a certain code. They probably even have it prepared in a form. Its only incumbent on you to ask for it.