Ob-Gyn Coding Alert

Hint: Mutually exclusive pairs mean you'll receive payment for lesser-valued codes

You may have a handle on the currently correct method for reporting colpopexy, but the rules for these claims have changed - thanks to new National Correct Coding Initiative edits that took effect July 1.

Mull Over 3 Colpopexy Edits

In accordance with the latest edits, you will no longer receive separate payment for 57283 (Colpopexy, vaginal; intra-peritoneal approach [uterosacral, levator myor-rhaphy]) and 57280 (Colpopexy, abdominal approach).
 
NCCI, version 11.2, says these ob-gyn procedures are mutually exclusive. This means that you cannot report both 57283 and 57280 on the same day and expect to receive reimbursement for both. Instead, Medicare will only pay for the lesser-valued of the pair. In this case, that would be 57283, which amounts to about $725, based on national averages.
 
Other mutually exclusive edits include the following code combinations:
 

58353/58563 (Endometrial ablation with and EA without hysteroscopy) and 58356 (Endometrial cryoablation with ultrasonic guidance, including endometrial curettage, when performed)
 

58615/58671 (Occlusion of fallopian tube[s] by device, open or laparoscopic) and Essure procedure 58565 (Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants).

NCCI has assigned each of these edits a status indicator of "0," so you cannot separate them with a modifier.

Check Out These Deleted Bundles

NCCI 11.2 includes multiple deletions of previously enacted ob-gyn edits. "In each case, these procedures have nothing to do with each other," says Harry Stuber, MD, FACOG, an independent gynecologist in Cookeville, Tenn.
 
For example, NCCI 11.2 deletes the bundle that previously made 58100 (Endometrial sampling [biopsy] with or without endocervical sampling [biopsy], without cervical dilation, any method [separate procedure]) a component to 57280 (Colpopexy, abdominal approach).
 
Also, you'll no longer have to worry when you report 44005 (Enterolysis [freeing of intestinal adhesion] [separate procedure]) or 44200 (Laparoscopy, surgical; enterolysis [freeing of intestinal adhesion] [separate procedure]) in addition to +59525 (Subtotal or total hysterectomy after cesarean delivery [list separately in addition to code for primary procedure]).
 
"That had to be an error at some point, so I'm pleased NCCI unbundled this combination," says Jeffrey Itkin, MD, FACOG, a former member of the American College of Obstetricians and Gynecologists Coding and Nomenclature Committee.
 
Finally, you have one repackaged edit. Before July 1, if you reported 58740 (Lysis of adhesions [salpingolysis, ovariolysis]) and 58700 (Salpingectomy, complete or partial, unilateral or bilateral [separate procedure]) together, carriers would deny the salpingectomy. With the correction, carriers will now deny lysis of adhesions instead.
 
"A salpingectomy is taking a portion of a tube out. If you have a few adhesions, you have to perform a lysis to get to the tube - so that's part-and-parcel of the procedure," Itkin says.

Read the Rest of the NCCI Ob-Gyn Story

New 2005 CPT codes for ob-gyn practices have yet again been doused with NCCI edits. For example, 58956 (Bilateral salpingo-oophorectomy with total omentectomy, total abdominal hysterectomy for malignancy) now has 64 new bundled codes. Only six of these edits can be bypassed with a modifier.
 
"I suspect that some day they'll revise all of these edits, sort of like they recently did with disorder of pelvic support. Until then, we'll just have to memorize what we have to work with," Stuber says.
 
Included as permanently bundled are codes for a staging, pelvic and retroperitoneal lymphadenectomy (38562, Limited lymphadenectomy for staging [separate procedure]; pelvic and para-aortic and 38770-38780). The reason for this edit is that CPT already has codes that include hysterectomy with lymphadenectomy, such as 58951 (Resection of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; with total abdominal hysterectomy, pelvic and limited para-aortic lymphadenectomy) and 58954 (Bilateral salpingo-oophorectomy ...; with pelvic lymphadenectomy and limited para-aortic lymphadenectomy).
 
Also bundled are codes for most of the CPT "separate procedures," as well as biopsy codes, most surgeries performed on the uterus, laparoscopic procedures, and most of the codes for surgery on the ovaries.

The only codes you can report with 58956 as a distinct procedure are:

49002 (reopening of a recent laparotomy)
 

49200/49201 (excision or destruction of an intra-abdominal or retroperitoneal tumor)
 

49322 (laparoscopic aspiration of an ovarian cyst)
 

49570 (epigastric hernia repair)
 

50715 (ureterolysis).