Ob-Gyn Coding Alert

NCCI 10.1 new deletions could mean an extra $96 for ultrasound procedures

Newly deleted edits in version 10.1 of the National Correct Coding Initiative (NCCI) make submitting 76830 and 76857 or 76856 acceptable when the ob-gyn performs both procedures during the same visit.

Effective April 1, NCCI 10.1 deletes three code edits that will impact ob-gyn practices. Significantly, the initiative no longer bundles a gynecologic transvaginal ultrasound (76830) with a complete ultrasound (76856, Ultrasound, pelvic [nonobstetric], B-scan and/or real time with image documentation; complete) or limited/follow-up gynecologic pelvic ultrasound (76857, ... limited or follow-up [e.g., for follicles]), says Melanie Witt, RN, CPC, MA, an ob-gyn coding expert based in Fredericksburg, Va.

The bottom line: This means that when the physician performs both a transvaginal ultrasound and a complete pelvic ultrasound, you can get paid for both. Each of the codes carries 2.57 relative value units (RVUs), so you will be reimbursed approximately $96 for each ultrasound.

Before NCCI 10.1, you could report these code pairs together only if the provider could meet the criteria for appending modifier -59 (Distinct procedural service) to the bundled transvaginal approach procedure. You should be aware, however, that even though NCCI has eliminated these bundles, each of these procedures should carry its own diagnosis code to show the medical necessity for performing both during the same session, Witt says.

"This is especially true for performing both a transabdominal and transvaginal approach ultrasound," Witt notes. If the ob-gyn routinely performs both ultrasounds on all patients without specific reasons for doing so, the payer may decide to include the second approach as a matter of course because it considers this the standard of care for the practice, despite the change to the NCCI, she says.

Endometrial Biopsy With Pessary Insertion Also Allowed

The third edit deletion allows you to bill for an endometrial biopsy (58100, Endometrial sampling [biopsy] with or without endocervical sampling [biopsy], without cervical dilation, any method [separate procedure]) when the physician does a pessary insertion (57160, Fitting and insertion of pessary or other intravaginal support device) at the same time, Witt says. Previously, NCCI bundled these two codes, and you could not use a modifier to bypass the edit.

Urodynamic Testing Edits Likely Won't Affect Ob-Gyns

In addition to the deletions in NCCI 10.1, the initiative includes 17 new edits involving the urodynamic testing codes 51784 (Electromyography studies [EMG] of anal or urethral sphincter, other than needle, any technique) and 51785 (Needle electromyography studies [EMG] of anal or urethral sphincter, any technique), says Terry Tropin, RHIA, CPC, CCS-P, manager of coding education for the American College of Obstetricians and Gynecologists (ACOG). Fortunately, ob-gyns or gynecologic urologists performing these tests need not be concerned, Witt says.

What this means: The new bundled codes relate to services that you likely would not report along with testing for urinary stress incontinence, such as audiologic function tests, routine electroencephalogram, electromyography and nerve conduction tests of the extremities, and evoked potentials and reflex tests, Tropin says. For example, NCCI now bundles 51784 and 51785 with 92585 (Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive) and 95860 (Needle electromyography; one extremity with or without related paraspinal areas).

Semen Analysis Now Includes Path Consult

In addition, NCCI 10.1 includes 80500 (Clinical pathology consultation; limited, without review of patient's history and medical records) and 80502 (... comprehensive, for a complex diagnostic problem, with review of patient's history and medical records) in G0027 (Semen analysis; presence and/or motility of sperm excluding Huhner). You can bypass this edit, however, by using a modifier if you meet the criteria for using modifier -59, Witt says. These bundled codes represent a limited and a comprehensive clinical pathology consultation, services that a pathologist, not an ob-gyn, normally would provide.

The new NCCI also bundles G0027 into the existing laboratory codes for semen analysis (89300, Semen analysis; presence and/or motility of sperm including Huhner test [postcoital]; 89310, ... motility and count [not including Huhner test]; 89320, ... complete [volume, count, motility, and differential]; and 89321, Semen analysis, presence and/or motility of sperm). Because this G code is an integral part of these lab procedures, you may never bill it with 89300-89321, Witt notes.