Ob-Gyn Coding Alert

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 [...]