Ob-Gyn Coding Alert

The latest version of the National Correct Coding Initiative (NCCI) contains 55 new edits that will impact ob-gyn practices, and all but five of these edits will never be paid by Medicare when they are billed together. NCCI version 9.1 went into effect April 1. Although the number of edits that will impact ob-gyn practices is not extensive this time, most of them represent services that Medicare will never pay for when billed together (which is denoted in NCCI by a 0"" payment indicator)" says Melanie Witt RN CPC MA an ob/gyn coding expert based in Fredericksburg Va. "The new version also provides some extensive 'house cleaning'by deleting existing edits for codes that are no longer valid for claims processing " Witt says. NCCI Takes on Surgical Procedures The good news is that there are no new mutually exclusive code edits in NCCI 9.1. When NCCI labels a bundle as mutually exclusive Medicare will pay only for the lower-valued code of the two.

Consequently the 55 new edits are all of the comprehensive/component variety. The five new surgical bundles that allow you to use a modifier (for example -59 Distinct procedural service) to bypass the edit are listed in the table in article 11. The 50 remaining bundles that Medicare will never pay when reported together (they have a "0" payment indicator) include the following:

1. You will never be paid for 56820 (Colposcopy of the vulva) when you bill it with 56501 (Destruction of lesion[s] vulva; simple [e.g. laser surgery electrosurgery cryosurgery chemosurgery]) 56633 (Vulvectomy radical complete) or 56805 (Clitoro-plasty for intersex state). 2. Do not bill 57061 (Destruction of vaginal lesion[s]; simple [e.g. laser surgery electrosurgery cryosurgery chemosurgery]) with 57421 (Colposcopy of the entire vagina with cervix if present; with biopsy[s]). 3. You cannot submit 57100* (Biopsy of vaginal mucosa; simple [separate procedure]) with 57421. 4. Medicare will deny 57420 (Colposcopy of the entire vagina with cervix if present) if you bill it with any of the following 18 procedure codes: 57155 Insertion of uterine tandems and/or vaginal ovoids for clinical brachytherapy
57220 Plastic operation on urethral sphincter vaginal approach (e.g. Kelly urethral plication)
57230 Plastic repair of urethrocele
57454-57461 Colposcopy of cervix procedures
57531 Radical trachelectomy with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling biopsy with or without removal of tube(s) with or without removal of ovary(s)
58145 Myomectomy excision of fibroid tumor(s) of uterus 1 to 4 intramural myoma(s) with total weight of 250 grams or less and/or removal of surface myomas; vaginal approach
58275-58294 Vaginal hysterectomy procedures. 5. NCCI 9.1 now permanently bundles 57421 into 57454* (Colposcopy of the [...]