Ob-Gyn Coding Alert

Lack of payment for category III codes doesn't mean you can ignore them

Have patients with uterine fibroids? Then you may start seeing an increase in a procedure called "myolysis." Get ahead of the game by learning about this new medical method - and how to code for it. Master Myolysis Knowledge Myolysis is a new experimental, minimally invasive procedure that shrinks uterine fibroids either alone or before removing them.
 
What happens: A patient presents with symptoms of menorrhagia, or pelvic pressure. The ob-gyn determines she has uterine fibroids. He pretreats the patient with a two- to six-month course of gonadotropin-releasing hormone analogues (GnRH-As) to shrink the fibroids. Then he inserts probes multiple times into the fibroid. When activated, various energy sources (such as, Nd:Yag laser, bipolar electrocautery, cryotherapy, radiofrequency ablation) induce devascularization of the fibroid and ultimately ablation of the target tissue.
 
When the ob-gyn uses radiofrequency, you should refer to the procedure as a HALT (Hysterectomy ALTernative) procedure, which you should report using the category III code 0071T (Focused ultrasound ablation of uterine leiomyomata, including MR guidance; total leiomyomata volume less than 200 cc of tissue) or 0072T (... total leiomyomata volume greater than or equal to  200 cc of tissue). 

Most often, the ob-gyn performs this procedure laparoscopically, but more recently, some ob-gyns have done this procedure percutaneously using magnetic resonance imaging guidance. The MRI provides guidance for the insertion of the probe as well as thermal imaging maps. 

Bad news: Because this procedure is new, you won't be reimbursed for it. Blue Cross Blue Shield of Massachusetts' policy is that 0071T and 0072T are "non-covered for all Plans, leaving no patient balance because these procedures do not meet our Medical Technology Assessment Guidelines."

However, if you have a Category III code for your procedure, you must use it. "Don't revert back to an unlisted-procedure code unless a payer instructs you to do so in writing," says Melanie Witt, RN, CPC, MA, an independent coding consultant from Fredericksburg, Va. "CPT rules are quite clear that if a category III code exists, it must be used because these are emerging technology codes and data need to be collected about their use before a category I code can be defended."