Ob-Gyn Coding Alert

Question:

Kansas Subscriber

The new edits have no major impact on ob-gyn practices.

If you're curious though, you will spot only four codes bundled into the CPT codes, and all four codes have to do with use of a local or an injection into the spine. CCI lists the reason for these edits as "misuse of a column 2 code with a column 1 code." The first two (listed below) have a "0" indicator, while the second 2 have a "1:"

Remember: A modifier indicator of "0" means you cannot separate the edit under any circumstances. A modifier indicator of "1" means you may apply a modifier (such as 59, Distinct procedural service) so long as you have supporting documentation.

Ob-gyns are highly unlikely to perform one of the first two codes at all. You might report one of the second two codes (J0670, J2001) for the injection of an anesthetic, but payers always include a local as part of any surgical procedure code. The injection would have to be unrelated to doing the surgery to get paid, essentially. The J2001 code is an IV administration which the physician would not do as a local and is not a substitute code for the Lidocaine that most physicians would inject when giving a local. Every code includes the 0213T/0126T bundle, but only some of the codes include the two J codes.

You'll also discover new bundling for codes G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination) and Q0091 (Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory), under the assignment of "standards of medical/surgical practice." You'll now bundle the codes for initial and follow-up inpatient telehealth (G0406-G0408, G0425-G0427) into these two codes. Because the provider who is billing for G0101 has to be physically present in order to bill, the telehealth codes (inpatient no less) do not apply at all. They have a "1" indicator which also makes no sense.