Ob-Gyn Coding Alert

Now you can report abdominal colpopexy and hysterectomy during the same session

Although there may be few important additions to Medicare's National Correct Coding Initiative (NCCI) with version 10.0, which took effect Jan. 1, there is a very welcome deletion.
 
For years, NCCI bundled an abdominal colpopexy (57280) when the surgeon also performed an abdominal hysterectomy during the same session. Due to the efforts of the American College of Obstetricians and Gynecologists (ACOG) to show that these are separate procedures, however, NCCI has deleted this code pair, says Melanie Witt, RN, CPC, MA, an ob-gyn coding expert based in Fredericksburg, Va.
 
On the other hand, if you are billing for the abdominal colpopexy, you will still need a viable medical indication for the procedure (such as vaginal prolapse), Witt adds. If the ob-gyn performs the colpopexy to prevent vaginal prolapse, the payer may deny reimbursement for the procedure, she warns.

Deletions Also Include Injections

NCCI also offers other deletions. For example, the edits now allow you to bill the injection code 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) with the vaccine/toxoid CPT combination codes 90723 (Diphtheria, tetanus toxoids, acellular pertussis vaccine, Hepatitis B, and poliovirus vaccine, inactivated [DtaP-HepB-IPV], for intramuscular use) and 90748 (Hepatitis B and Hemophilus influenza b vaccine [HepB-Hib], for intramuscular use), Witt says.
 
In addition, NCCI unbundled 96155 (Health and behavior intervention, each 15 minutes, face-to-face; family [without the patient present]) from all of the E/M services codes.

Mark These New Edits for New Codes

NCCI added a few edits that will impact ob-gyn practices, but they include only the newly added CPT codes, Witt notes. These bundles, listed below, allow you to use modifier -59 (Distinct procedural service) to bypass the edit in all but a few cases - as long as you meet the criteria for using this modifier and this has been documented, says Terry Tropin, RHIA, CPC, CCS-P, ACOG's manager of coding education. You should use modifier -59 for procedures or services that are not normally reported together but are appropriate under the circumstances, such as when the procedures are performed during a different encounter, at a different site or organ system, or separate incision, among others, according to CPT.
 
Although NCCI has assigned an indicator "1" to some of the bundles, billing for a few of these procedures would not be correct under any circumstances based on the CPT definition, Witt says. Specifically, CPT includes cystourethroscopy (52000) with 53500 (Urethrolysis, transvaginal, secondary, open, including cystourethroscopy [e.g., postsurgical obstruction, scarring]) and ultrasound guidance with the new codes for fetal surgery codes (59070-59076). This means that although NCCI permits you to use modifier -59 with 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) or 76986 (Ultrasonic guidance, intraoperative) if you meet the criteria, CPT expressly states that the fetal surgery includes any guidance, and therefore you should not bill for it in addition if this guidance is related to performing the procedure.
 
The following chart details some of the new bundles that affect the new codes for 2004. Unless otherwise noted, the bundles carry a "1" modifier indicator, meaning you may bypass the edit with a modifier if the circumstances permit.

Existing Codes Take a Hit as Well

NCCI also added a new bundle or two to some existing codes. A new edit bundles the laboratory code 87660 (Infectious agent detection by nucleic acid [DNA or RNA]; Trichomonas vaginalis, direct probe technique) into 87800 (Infectious agent detection by nucleic acid [DNA or RNA], multiple organisms; direct probe[s] technique) unless this combination represents different organisms.
 
Similarly, version 10.0 bundles the supply code J1644 (Injection, heparin sodium, per 1,000 units) with 58340 (Catheterization and introduction of saline or contrast material for saline infusion sonohysterography [SIS] or hysterosalpingography). And the new NCCI includes 01958 (Anesthesia for external cephalic version procedure) with all of the delivery codes and those for external cephalic version (59400-59412, 59510-59514, 59610-59622). This should not impact obstetricians, however, because the doctor who delivers the baby or performs the version procedure would not, under CPT rules, ever bill the anesthesia using the anesthesia codes, Witt says. Generally, anesthesia codes are reserved for the anesthesiologist, whereas the surgeon would report any anesthesia services by appending modifier -47 (Anesthesia by surgeon) to the surgical code reported.