Ob-Gyn Coding Alert

The Centers for Medicare & Medicaid Services (CMS, formerly HCFA) released the latest Correct Coding Initiative (CCI) version 7.2 with an effective date of July 1, 2001. A total of 77 codes are affected by the addition of at least one new bundled code -- 10 from the urinary system section of CPT and 67 in the female genital system and maternity-care sections. The changes to existing bundles that will have an impact on ob/gyn practices are not extensive and mainly involve the bundling of laparoscopic lysis codes (44200 and 58660) and the code for reopening a recent laparotomy with other open, laparoscopic and hysteroscopic procedures.
 
For example, 44200 (laparoscopy, surgical; enterolysis [freeing of intestinal adhesion] [separate procedure]) is bundled into 56 laparoscopic and open-procedure codes that are frequently reported by ob/gyns. The majority of the new bundles allow coders to bypass the edit with the proper use of  modifier -59 (distinct procedural service). Remember, however, that this modifier can only be used when the bundled procedure represents a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion or separate injury, and, per the CPT guidelines, is "not ordinarily encountered or performed on the same day by the same physician."
 
A few of the newly bundled codes can never be billed in conjunction with the "comprehensive code." Medicare has stated, however, that while a modifier may not be used to bypass the edit for these code combinations, they will consider the claim if the physician can show that the work involved with the bundled procedure was extensive and added significant risk to the patient. For a review of the claim, add modifier -22 (unusual procedural services) to the comprehensive code and include documentation supporting the request for additional reimbursement.
 
The newly bundled code combinations that cannot be bypassed by a modifier in version 7.2 of the CCI include the following (see table above):

For a full list of the bundles, ob/gyn practices are encouraged to subscribe to CCI, available in printed or CD-ROM format. Call the National Technical Information Service (NTIS) at 1-800-363-2068.