Ob-Gyn Coding Alert

New bundles under the National Correct Coding Initiative (NCCI) mean you won't be able to report epidural administration and other regional blocks during labor management with maternity codes.

NCCI Edits , version 9.2, went into effect July 1. "Although the number of edits that will impact ob-gyn practices is not extensive, most of them represent services that Medicare will never pay for when billed together payment indicator '0' but the maternity code bundles may have far-reaching implications for obstetricians," says Melanie Witt, RN, CPC, MA, an ob-gyn coding expert based in Fredericksburg, Va. Labor and Delivery Include Epidurals NCCI 9.2 continues CMS' bundling of anesthetic codes. Prior to this version, several bundles appeared for epidural anesthesia, but you could bypass these bundled codes using an appropriate modifier if the documentation supported it, Witt says. With version 9.2, CMS has added four regional block procedures to almost all of the Maternity Care and Delivery codes beginning with 59100 (Hysterotomy, abdominal [e.g., for hydatidiform mole, abortion]). The difference this time is that you cannot bypass these bundles with a modifier, she points out. The four bundled procedures are the following:
   62311 Injection, single (not via indwelling    catheter), not including neurolytic substances, with or   without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other salutation), epidural or    subarachnoid; lumbar, sacral (caudal)
   64430* Injection, anesthetic agent; pudendal nerve
   64435* Injection, anesthetic agent; paracervical (uterine) nerve
   64483 Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level. Bone Density Studies Are Now Mutually Exclusive There are only a few new "mutually exclusive" code edits in NCCI 9.2, mostly associated with bone density studies. If you bill mutually exclusive codes for the same patient on the same date, Medicare and many other carriers will only pay the code with the lower reimbursement value, says Mary Mulholland, BSN, RN, CPC, a reimbursement analyst for the office of clinical documentation at the University of Pennsylvania's department of medicine in Philadelphia. This relationship does not appear to apply to the medicine-procedure code bundles. For this version, you can override only two of the mutually exclusive bundles for the comprehensive code 78350 with a modifier, she adds. The bundles are as follows: (please see the first chart at the top of this article) Watch for 24 New Edits Despite the relatively few new mutually exclusive edits, version 9.2 includes 24 new surgical comprehensive/component edits that will impact ob-gyn practices, Witt says. Medicare and those payers that follow NCCI will never pay all but three of these edits when you bill the codes together with a modifier.

The new surgical bundles that [...]