Ob-Gyn Coding Alert

Red flag: Your new codes aren't the only ones slammed with NCCI edits You-ve got to get the full National Correct Coding Initiative version 13.0 picture and know how it affects your ob-gyn practice -- and now. You-ve got no grace period. Don't be daunted by thousands of edits. Our experts highlight what's most important. New Supracervical Hysterectomy Codes Hit Hard If you-re still rejoicing over the new laparoscopic supracervical hysterectomy codes CPT added for 2007, you may want to rethink your elation. NCCI 13.0 applies a slew of edits to these codes:

- 58541 -- Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less

- 58542 -- - with removal of tube(s) and/or ovary(s)

- 58543 -- Laparoscopy, surgical, supracervical hysterectomy, for uterus greater   than 250 g

- 58544 -- - with removal of tube(s) and/or ovary(s). First, NCCI renders 58541-58544 -mutually exclusive- with vaginal and open supracervical codes including, but not limited to, 58152-58240, 58262-58294, and 58550-58554.

What that means: Mutually exclusive edits pair procedures that an ob-gyn would not reasonably perform at the same session, on the same anatomic location, or on the same beneficiary. If you were to report both these services, Medicare would pay only for the lesser valued of the two procedures.

Example: If you were to report both 58542 and 58270 (Vaginal hysterectomy, for uterus 250 grams or less; with repair of enterocele), you would receive payment only for the lesser-valued procedure -- in this case, 58270.

Keep in mind: When an edit pair has a modifier indicator status of -1,- you can separate it using a modifier (such as 59, Distinct procedural service) -- as long as you have supporting documentation. When the modifier indicator is -0,- you cannot separate the edit under any circumstances.

For these mutually exclusive edits, however, you can separate these edits with a modifier because they carry a status indicator of -1.-

Also, NCCI bundles 58541-58544 as mutually exclusive to the other approach codes for hysterectomy (58152-58294) and the laparoscopic-assisted vaginal hysterectomy (LAVH) codes (58550-58554). You can separate this edit if your ob-gyn started performing the hysterectomy with one approach, then converted to a different approach, says Melanie Witt, RN, CPC-OGS, MA, an ob-gyn coding expert based in Guadalupita, N.M. -But you should keep in mind that Medicare has a rule that if this is the case, you should only report the final approach surgery.- Know These NME Hysterectomy Edits, Too The edits for 58541-58544 are not limited to mutually exclusive pairs. You-ve got tons of comprehensive/ component edits to sort through as well. [...]