Ob-Gyn Coding Alert

The National Correct Coding Initiative (NCCI) version 10.2 didn't stop with new mutually exclusive edits. You'll find scores of new nonmutually exclusive (NME) code bundles in the new version, so get ready to determine whether your claims warrant modifier -59 (Distinct procedural service) to separate the code combinations. Nonmutually exclusive bundling edits pair codes for services included as part of more global (or comprehensive) procedures.

The majority of these types of edits permit you to use a modifier to bypass the bundle. But keep in mind that you must meet the criteria of modifier -59, says Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting in Denver. Otherwise you cannot separate the services. In other words, you should use modifier -59 only for procedures or services that you would not normally report together, but are appropriate under the circumstances, such as when your ob-gyn performs a procedure during a different encounter, at a different site or organ system, or separate incision, among other reasons, according to CPT. Bundles for 'Standard of Medical/Surgical Practice' Cervical colposcopy codes 57455 (Colposcopy of the cervix including upper/adjacent vagina; with biopsy[s] of the cervix) and 57456 (... with endocervical curettage) now include 57410 (Pelvic exam under anesthesia) as a standard of medical and surgical practice. According to Medicare, standard of medical and surgical practice means "generic activities assumed to be included" and "integral to accomplishing a procedure."

Other new bundling edits that the NCCI added to this category include 57460 (Colposcopy of the cervix including upper/adjacent vagina; with loop electrode biopsy[s] of the cervix), which now bundles into 57400 (Dilation of vagina under anesthesia); and 57461 (Colposcopy of the cervix including upper/adjacent vagina; with loop electrode conization of the cervix), which the NCCI now bundles into 57400.

NCCI 10.2 institutes dozens of edits based on a potential misuse of a Column 2 code with a Column 1 code. According to CMS, these edits do not involve "a comprehensive/component relationship" but "are codes that should simply not be reported together for other reasons, such as the misuse of the code."

For example, the NCCI now bundles 57420 (Colposcopy of the entire vagina, with cervix if present) into rectovaginal fistula closure code 57308 (Closure of rectovaginal fistula; transperineal approach, with perineal body reconstruction, with or without levator plication). And code 57308 includes 57452 (Colposcopy of the cervix including upper/adjacent vagina). Also, you should note that the NCCI now bundles the myomectomy code 58145 (Myomectomy, excision of fibroid tumor[s] of uterus, 1 to 4 intramural myomas[s] with total weight of 250 grams or less and/or removal of surface myomas; vaginal approach) into codes 58950 (Resection of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy) and 58952 [...]