Ob-Gyn Coding Alert

Tests with different names don't always mean different codes

Tackle your most common ob-gyn tests to make sure you-re coding them correctly and reining in the appropriate payment for these in-office tests.

Mark the Most Common: Urinalysis

Your ob-gyn will likely report a urinalysis to check for pregnancy more than any other test. You-ll report it using 81025 (Urine pregnancy test, by visual color comparison methods). The results are immediate, so your ob-gyn has no need to send the specimen to an outside laboratory.

Note: You won't include most tests in your E/M fee. You can report lab tests in addition to your E/M code (99201-99205 for new patients, 99211-99215 for established patients).

Important: The Clinical Laboratory Improvement Amendments (CLIA) deemed the urine pregnancy test as a -waived- test, meaning this test is so simple that little risk of error exists. Caution: You still need a certificate to perform a waived test. The law requires that all laboratories have a certificate and obtain a CLIA number. So when you report the urine pregnancy test, you would also apply modifier QW (CLIA-waived test) to 81025. Be sure to include your CLIA number on the claim form.

Want to see if your in-house tests are CLIA-waived? For a free list of current CLIA-waived tests, e-mail suzannel@eliresearch.com.

Code the Following 3 Tests Using 87210

Don't be fooled--just because some in-house tests have different names doesn't mean you should report a different code for each.

Wet mount: When the ob-gyn does a wet mount, he swabs the vagina, puts the sample on a glass microscope, and mixes it with a salt solution, says Barbara White, billing supervisor of Women's Total Care of East Texas in Jacksonville. He examines the prepared slide under the microscope and checks for bacteria, yeast cells, trichomoniasis organisms (trichomonads), white blood cells indicating an infection, or clue cells that indicate bacterial vaginosis. -This involves a smear specimen for infectious agents,- says Terri R. Viar, CPC-A, an ob-gyn coder at Women's Care PA in Shawnee Mission, Kan.

KOH slide: This lab test mixes the vaginal sample with potassium hydroxide (the KOH) in addition to the salt solution. The KOH destroys bacteria and cells from the vagina, leaving yeast hyphae and spores (if present) that indicate a yeast infection.

Whiff test: The whiff test is another part of the KOH test procedure. The physician will smell the sample that was prepared with the potassium hydroxide to see if a strong fishy odor is present. If so, the odor suggests bacterial vaginosis. -If the ob-gyn smells a fishy -amine- odor, most likely they have bacterial vaginosis,- says Mary Lou Martin, CMM, CPC, a healthcare consultant at Skoda, Minotti & Co. Healthcare Services in Cleveland. (Note: See section below for Amine test.)

You can represent all of these tests (wet mount, KOH slide, whiff test) using 87210 (Smear, primary source with interpretation; wet mount for infectious agents [e.g., saline, India ink, KOH preps]).
 
Important rule: If your ob-gyn does both a KOH and wet mount, you should report 87210 twice. If your ob-gyn does a KOH, you should not report the whiff test separately because the whiff test is part of the KOH test method.

Warning: You should never use 87220 (Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites [e.g., scabies])--unless the sample the ob-gyn tests with KOH consisted of skin, hair or nails. CPT revised this code in 2001 to specify the sample source and the organism for examination.

Keep in mind that for Medicare you would use a Q code: Q0111 (Wet mounts, including preparations of vaginal, cervical or skin specimens) and Q0112 (All potassium hydroxide [KOH] preparation).
 
Example: A patient presents with foul odor with vaginal discharge. The ob-gyn performs a wet mount and diagnoses bacterial vaginosis.
 
You would report the appropriate-level E/M service (such as 99213, Office or other outpatient visit for the evaluation of management of an established patient -) without modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) because a laboratory service is not a procedure. Then you-d report the wet-mount code (87210) for a private payer or the equivalent Q code (Q0111) to Medicare.

Don't Overlook the Other In-House Tests

Your ob-gyn may also perform a vaginal pH test, amines test and fecal occult tests in-house, so you need to know what these tests are and how to code them.

Vaginal pH: This test returns a value for the pH of the vagina. The normal vaginal pH is 3.8 to 4.5. Bacterial vaginosis, trichomoniasis and atrophic vaginitis frequently cause a vaginal pH greater than 4.5. You-d report this test with 83986 (pH, body fluid, except blood).

The amines test: This test detects the presence of volatile amines greater than 0.50 mM. In the whiff test, the ob-gyn simply smells the sample. With the amines test, the ob-gyn can determine a quantitative result. That's news to some coders. -I did not realize that there's an actual measurement threshold for the whiff test,- Martin says. You-d report the amines test using 82120 (Amines, vaginal fluid, qualitative).
 
Fecal occult tests: You-ll report these with 82270 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative; feces, 1-3 simultaneous determinations) or 82274 (Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations).  When billing Medicare, you should report G0107 (Colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations) or G0328 (Colorectal cancer screening; fecal-occult blood test, immunoassay,  1-3 simultaneous determinations).

Try These In-House Lab Examples

Think you know how to use the above tests? Try these two documentation examples.

Example 1: Your ob-gyn documents -wet prep, pH<4.5 + whiff + clue.- What should you report?

The ob-gyn performed a vaginal pH (<4.5), which means you should report 83986. He also did a whiff test (-+ whiff-), which you-d report using 87210, and a wet mount (-+ clue-), which you-d report using 87210 a second time.

Example 2: Your ob-gyn documents -+ clue + hyphae + whiff.- What should you report?

Again, the -+ clue- stands for the wet mount, so you-d report 87210. The -+ hyphae- is for the yeast hyphae, meaning the ob-gyn performed a KOH slide--a second unit of 87210. Before you decide to report a third unit of 87210, you should realize that a whiff test (-+ whiff-) is part of a KOH process. Keep in mind: This is the rule. Youcan report 87210 for a whiff test, but if you-re going to report a KOH slide as well, you cannot report 87210 a second time.