Ob-Gyn Coding Alert

Hint: You can only report one type of colpopexy per surgical session

Your ob-gyn practice only has to worry about three new National Correct Coding Initiative (NCCI)  bundles in version 11.1. All of them went into effect April 1 and have been assigned a modifier indicator of "0."

Remember: A status modifier indicator of "0" means that the bundle cannot be broken under any circumstances, says Paula Okano, CPC, a medical biller for Retina Associates of Hawaii in Honolulu. Edit #1: NCCI bundles 57282 (Colpopexy, vaginal; extra-peritoneal approach) into 57425 (Laparoscopy, surgical, colpopexy [suspension of vaginal apex]).

Rationale: You can bill for only one type of colpopexy at the surgical session. Both 57425 and 57282 achieve the same goal by different methods, says Judy Troy, surgical posting/coding coordinator-division 22 of Capital Women's Care in Silver Spring, Md. Edit #2: You can no longer separately report 52000 (Cystourethroscopy [separate procedure]) and 57288 (Sling operation for stress incontinence [e.g., fascia or synthetic]) because NCCI bundles the cystoscopy into the sling procedure. 

Keep in mind: If your ob-gyn's documentation indicates a separate medical indication for performing cystoscopy at the time of the sling procedure, such as bleeding from the bladder or to diagnose a bladder condition, the only way to get it paid is to add modifier -22 (Unusual procedural services) to the sling procedure. Otherwise this code is always bundled. Edit #3: Also affected by NCCI version 11.1 is 78730 (Urinary bladder residual study). NCCI has bundled this urinary bladder residual study into 52000 (Cystourethroscopy [separate procedure]) and into all of the urodynamics codes (51725-51798).
 
In other words: Payers consider this study an integral part of each of the urodynamic tests, when the ob-gyn performs these services.