Ob-Gyn Coding Alert

Home in on your modifier indicator before separating edits

If your ob-gyn practice administers intramuscular (IM) and arterial injections, you-ll no longer be able to report the nurse visit separately.
 
In one of the few edits with a -0- modifier indicator, you-ll have to include the work involved with 99211 (Office or other outpatient visit for the E/M of an established patient ...) in the arterial injection (90783, Therapeutic, prophylactic or diagnostic injection [specify material injected]; intra-arterial) or in the IM injection (90788, Intramuscular injection of antibiotic [specify]).
 
There's no way to report a modifier to get around this edit. This may not affect your coding practice because -we charge the injection code only when the patient is seen by a nurse and not a doctor,- says Sue Lodding, an ob-gyn office manager of Drs. Lorenzini, Senica & Bruneau Ltd. in Downers Grove, Ill.

NCCI 11.3 also bundles Medicare injection codes G0351-G0354 into aspiration codes 10021 (Fine needle aspiration; without imaging guidance) and 10022 (- with imaging guidance), as well as 0071T (Focused ultrasound ablation of uterine leiomyomata, including MR guidance; total leiomyomata volume less than 200 cc of tissue) and 0072T (- total leiomyomata volume greater than or equal to 200 cc of tissue). You can separate this edit with a modifier, and documentation must support that modifier's use.

You-ll also find that NCCI 11.3 bundles all the outpatient E/M codes (99201-99215) into the new Medicare injection codes G0351 (Therapeutic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) and G0353 (Intravenous push, single or initial substance/drug) with a modifier indicator of -1.-

Remember: The NCCI assigns a modifier indicator for each code pair (column 1 and column 2) listed in the edits to tell you which codes you can unbundle and how. The -0- indicator means you may not use any modifier to unbundle the edit under any circumstances.

The -1- indicator means you can use an appropriate modifier in some situations to unbundle the edit and receive payment for both codes. For example, NCCI may list two codes as bundled together, but if your ob-gyn performs the services during separate encounters on the same day, you may be able to report both codes with modifier 59 (Distinct procedural service).