Ob-Gyn Coding Alert

Follow-up inpatient consults are out; find out what you should report instead

On Jan. 1, you-ll have to alter the way you report vaginal grafts, endometrial biopsies, and inpatient consultations.

Familiarize yourself with these 2006 CPT changes now and prepare for smooth sailing in 2006. Revise How You Code Vaginal Grafts If you-ve been reporting vaginal graft revision using 58999 (Unlisted procedure, female genital system [nonobstetrical]), get ready to use a brand-new code. CPT has added 57295 (Revision [including removal], vaginal approach).

Example: Your ob-gyn performs surgery on a patient for prolapse, which requires a vaginal graft during the repair. You report this procedure using one or more of the following codes:

- add-on code +57267 (Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site [anterior, posterior compartment], vaginal approach [list separately in addition to code for primary procedure]) 

- colporrhaphy codes (57240-57265)

- rectocele repair code 45560 (Repair of rectocele [separate procedure])

- abdominal approach colpopexy code 57280 (Colpopexy, abdominal approach). The surgery, however, results in a complication with a graft, and your ob-gyn has to go back to revise the graft.

In the past: -While we have a code for the revision of a sling procedure for stress urinary incontinence, the only way to report the revision of a vaginal graft was to use 58999,- says Melanie Witt, RN, CPC, MA, an independent coding consultant in Guadalupita, N.M.

In 2006: As of Jan. 1, you-ll be able to use new code 57295 instead. Enter the New Endometrial Biopsy Code Another new code you-ll have in 2006 is an add-on code for endometrial biopsies: +58110 (Endometrial sampling [biopsy] performed in conjunction with colposcopy [list separately in addition to code for primary procedure]).

Example: The ob-gyn, when performing a colposcopy, wants to perform an endometrial biopsy in addition to any cervical or vaginal biopsy.
 
In the past: If you tried to report the endometrial biopsy code 58100 (Endometrial sampling [biopsy] with or without endocervical sampling [biopsy], without cervical dilation, any method [separate procedure]), most carriers would deny your claim. The National Correct Coding Initiative bundles this procedure with all colposcopy codes that include a vaginal or cervical biopsy (57421, Colposcopy of the entire vagina, with cervix if present; with biopsy[s]; and colposcopy of the cervix codes 57454-57461).

In 2006: -The new code, 58110, takes care of this problem because the resource-based relative value system (RBRVS) values this code for the intra-service work only,- Witt says.

Bonus: When you receive your 2006 CPT book, you-ll find that CPT added notes under colposcopy codes 57420 (Colposcopy of the entire vagina, with cervix if present), 57421 (- with biopsy[s]) and 57452-57461. These notes indicate that if the ob-gyn also performs an endometrial biopsy, you should report 58110 in [...]