Ob-Gyn Coding Alert

Remember: Check your modifier indicator before tacking on modifier 59

If you-ve acquainted yourself with all of CPT 2006's new ob-gyn-related codes, your work is only half done, thanks to a slew of new edits in the National Correct Coding Initiative (NCCI), version 12.0.

You don't have any time to waste learning these edits because they took effect Jan. 1. How 44180 Takes the Brunt of New Edits You-re likely to see a lot of denials revolving around the new code 44180 (Laparoscopy, surgical, enterolysis [freeing of intestinal adhesion] [separate procedure]) because of NCCI 12.0.

First, NCCI indicates that when your ob-gyn performs 44180, you should forgo reporting the following codes separately:   Column 1  
   
44180   
Column 2

36000, 36410, 37202, 43752, 44701, 49320, 62318, 62319, 64415-64417, 64450, 64470, 64475, 69990, 90760, 90765, 90772, 90774, 90775, C8950, C8952  Catch this: You can use a modifier to separate the edits for all of these combinations -- except when your ob-gyn performs 44180 and 49320 (Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) or 44180 and +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]).

In both of these situations, you-ll find a modifier indicator of -0,- meaning you cannot separate this edit under any circumstances. Result: If you try to report 44180 and 49320 or 44180 and 69990 separately, you-ll receive a denial and only be reimbursed for 44180, says Melanie Witt, RN, CPC-OGS, MA, an ob-gyn coding expert based in Guadalupita, N.M.

On the other hand, NCCI 12.0 also makes 44180 a component code to many other procedures. The following edits have a modifier indicator of -0-:

Do Not Separate These Edits 

Column 1        

44005, 44970, 49321, 49322, 51990, 51992, 57280, 57283, 57425, 58150, 58545-58554, 58660-58662, 58670-58673, 58740, 58940, 58953-58956  

Column 2 

44180 
Example: If your ob-gyn performs 58550 (Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 grams or less) and the work represented by 44180, you should report only 58550. Medicare, and payers that follow Medicare's guidelines, will not pay for 44180 if you tried to report it separately.

NCCI 12.0 also bundles 44180 with other procedures but allows you to bypass the edit if your documentation meets the criteria. These edits have a modifier of -1-:
You Can Separate These Edits If Necessary 

Column 1 

57270, 57282, 57305, 57307, 57540, 57545, 58140, 58146, 58152-58240, 58400-58540, 58600-58615, 58700, 58720, 58750-58770, 58805, 58822, 58825, 58900-58925, 58943-58952, 58960, 59100-59140, 59325, 59350, 59510-59515, 59620, 59622, 59857

Column 2  

44180

Example: If your ob-gyn performs a colporrhaphy (57270, Repair of enterocele, abdominal approach [separate procedure]) as well as a laparoscopic enterolysis (44180), you could report both codes, adding modifier 59 (Distinct procedural service) to 44180. Just make sure your ob-gyn's documentation shows that he [...]