Ob-Gyn Coding Alert

CPT will offer new code in 2005 for permanent solution Beginning April 1, you have a new tool in your arsenal for coding the Essure procedure, S2255. So you won't have to rely on the unlisted-procedure code.

The new HCPCS code, S2255 (Hysteroscopy, surgical; with occlusion of oviducts bilaterally by micro-inserts for permanent sterilization), presents a solution for many coders. Because some payers do not accept 58579 (Unlisted hysteroscopy procedure, uterus), coders were left with less accurate alternatives for reporting this procedure. Now, they have a specific code that directly addresses the surgery.

"This new code indicates some of the positive changes we will be seeing thanks to initiatives to respond more quickly to new technologies," says Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C.

Generally, the Blue Cross/Blue Shield Association (BCBSA) and the Health Insurance Association of America (HIAA) use S codes to report drugs, services and supplies for which there are no national codes, according to the HCPCS manual. These are codes private payers need to implement policies, programs or claims processing.

Good news: CPT 2005 will include a permanent code for the Essure procedure, a reputable source who prefers to remain anonymous tells Ob-Gyn Coding Alert. This new CPT code will replace S2255 in January. What Is Essure? Ob-gyns use the Essure micro-insert as a new tubal ligation device. The surgeon uses a hysteroscope to place the insert into the proximal portion of each fallopian tube. When he releases the device, it expands and anchors in the fallopian tube where it will cause tissue to form around it that a few months later will block the tube. This results in sterilization. The ob-gyn can perform the procedure in the office under local anesthesia or conscious sedation, and it takes about 35 minutes to complete.

The patient must remain on birth control until the physician can perform a hysterosalpingogram (74740, Hysterosalpingography, radiological supervision and interpretation; and 58340, Catheterization and introduction of saline or contrast material for saline infusion sonohysterography [SIS] or hysterosalpingography) after three months to verify that the tubes are blocked. How Does S2255 Help? Before S2255, many coders were tempted to use 58615 (Occlusion of fallopian tube[s] by device [e.g., band, clip, Falope ring] vaginal or suprapubic approach) for the Essure procedure because the surgery involves occluding the fallopian tubes by a device through the vaginal canal, says Penny Schraufnagel, office manager for Ob-Gyn Center PA in Boise, Idaho. But CPT guidelines state that you should select a code that accurately identifies the service performed, not merely because it approximates the service provided.

Warning: CPT created 58615 to report a vaginal or suprapubic surgical approach to occluding the fallopian tubes. The Essure procedure, on the other [...]