Ob-Gyn Coding Alert

Question: We have started billing for speculoscopy with 0031T, and we got our first denial from Medicare stating that it does not recognize the code. Medicare also stated that we should have used a modifier with the code. How should we have reported this service? Kansas Subscriber Answer: Because 0031T (Speculoscopy) is still an investigational procedure, Medicare will not reimburse for it. In fact, Medicare generally never covers investigational procedures. Similarly, most payers probably will want more information before deciding to pay for this service. Nonetheless, you should not have to use a modifier with 0031T. You may have to add modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to any E/M code you may be billing with it.

If you are reporting this service to Medicare, be sure to have the patient sign an advance beneficiary notice (ABN), which will inform her that the carrier may not cover the procedure and she will be responsible if Medicare denies the claim. In this case, be sure to add modifier -GA (Waiver of liability statement on file) to 0031T. On the other hand, if the carrier maintains that it will never cover this service, you should append 0031T with modifier -GY(Item or service statutorily excluded or does not meet the definition of any Medicare benefit). With this modifier, the patient does not have to sign an ABN for you to collect the service fee.