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Ob-Gyn Coding Alert

NCCI 10.3 Aftermath:

Don't Report 57410 Separately From Surgical Procedures

Published on Mon Sep 27, 2004

Ultrasound guidance edits allow modifier -59

If you're reporting 57410 with genital system surgery codes, you'll experience denials.
 
The National Correct Coding Initiative (NCCI) 10.3 edits, which go into effect  Oct. 1, include three changes that may impact ob-gyn practices. 

57410 Bundled Into Female Genital and Maternity Surgical Codes

First, NCCI has permanently bundled the code for an examination under anesthesia (57410, Pelvic examination under anesthesia) into certain female genital system surgery codes that previously did not have this bundle.
 
This does not come as a surprise" " says Judy Troy surgical posting/coding coordinator-division 22 of Capital Women's Care in Silver Spring Md. "I have always found 57410 to be an integral part of any pelvic procedure."
 
Red flag: Don't try to report 57410 separately from surgical procedure codes in the maternity section of CPT either because NCCI also bundled 57410 into codes such as amniocentesis fetal surgery and abortion procedures. Heads-up though - these edits cannot be overridden with a modifier.

You Need a Separate Indication for Ultrasound Guidance


Second NCCI has bundled ultrasound guidance for needle placement (76942 Ultrasonic guidance for needle placement [e.g. biopsy aspiration injection localization device] imaging supervision and interpretation) into introduction codes 58340-58345 58823 (Drainage of pelvic abscess transvaginal or transrectal approach percutaneous [e.g. ovarian pericolic]) 58970 (Follicle puncture for oocyte retrieval any method) and 59000 (Amniocentesis; diagnostic) and antepartum services codes 59012-59015.   
 
"In most cases CPT has indicated a different radiological supervision code to be reported with the surgical code and therefore these bundles should have no impact on current coding practices " says Melanie Witt RN CPC MA an Orthopedic Coding expert based in Fredericksburg Va.
 
Keep in mind: NCCI permits a modifier to bypass the edit but you should have a separate indication for the ultrasound guidance for it to be considered a distinct procedure and eligible for use of modifier -59 (Distinct procedural service) Witt says. 
 
Listed below are the column 1 codes that are affected by this new bundle. We have also listed radiological or ultrasound codes that are not bundled and that CPT indicates would be appropriate to bill with each of these.

 

  • 58340 - Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or hysterosalpingography. You should report 76831 (Saline infusion sonohysterography [SIS] including color flow Doppler when performed) with the SIS procedure and 74740 (Hysterosalpingography radiological supervision and interpretation) with the hysterosalpingogram (HSG) procedure.
     
  • 58345 - Transcervical introduction of fallopian tube catheter for diagnosis and/or re-establishing patency [any method] with or without hysterosalpingography. You should report this procedure with 74742 (Transcervical catheterization of fallopian tube radiological supervision and interpretation).
     
  • 58823 - Drainage of pelvic abscess transvaginal or transrectal approach percutaneous (e.g. ovarian pericolic). CPT indicates that you should look to 75989 (Radiological guidance [i.e. fluoroscopy ultrasound or computed tomography] for percutaneous drainage [e.g. abscess specimen collection] with placement of catheter radiological supervision and interpretation) for this procedure.
     
  • 58970 - Follicle puncture for oocyte retrieval any method. Report with 76948 (Ultrasonic guidance for aspiration of ova imaging supervision and interpretation).
     
  • 59000 - Amniocentesis; diagnostic. Report with 76946 (Ultrasonic guidance for amniocentesis imaging supervision and interpretation).
     
  • 59012 - Cordocentesis [intrauterine] any method.  Report with 76941 (Ultrasonic guidance for intrauterine fetal transfusion or cordocentesis imaging supervision and interpretation).
     
  • 59015 - Chorionic villus sampling any method. Report with 76945 (Ultrasonic guidance for chorionic villus sampling imaging supervision and interpretation).

    Can't Override Initial and Follow-Up Inpatient Consult Bundle

    Finally NCCI bundled the initial and follow-up inpatient consultation codes (99251-99263) into the codes for same-day observation or hospital admission and discharge (99234-99236).
     
    Translation: In other words you can no longer bill for a consult if the physician also placed the patient under observation or admitted him as an inpatient. Further you can't override these edits using a modifier.
     
    "If one of our doctors was asked for an initial or follow-up consultation then I would not expect him to report the observation or hospital admission/discharge because that should be billed by the attending doctor " says Penny Schraufnagel office manager of OB-GYN Center PA in Boise Idaho.
     
    If the physician already codes for observation or hospital admission he could not also code for an inpatient consultation on the same patient Schraufnagel says so the edit does not make much sense.
     
    CMS has identified the reason for the edit as "a coding manual instruction/guideline " and while CPT guidelines do indicate that the physician should report only the most extensive E/M service provided on a given date of service these bundled codes would be almost impossible to report together under normal circumstances.
     
    If the physician performed an inpatient consultation he could not then admit the patient to observation or inpatient care on the same date unless she was discharged from the hospital after the consultation and readmitted by the physician who did the consultation later that day. And if the physician admitted the patient to observation or inpatient care first he could not do the inpatient consultation.
     
    Sometimes the edits just do not make sense Witt says "At least this one will have absolutely no impact on ob-gyns."
     
    There were no deleted edits that would impact ob-gyn practices.

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