Ob-Gyn Coding Alert

If your practice sees a patient for the first time to perform a starred surgical procedure, how should the visit itself be coded? Were finding that some carriers will not pay for an evaluation and management service on the same day as a surgical procedure, says Renie Galford, business manager of Augusta Health Care for Women in Fishersville, VA. Galford and other OCA readers have been questioning the possible use of CPT code 99025 to secure visit payment.

Code 99025 is listed in the CPT Medicine section under special services and reports. These codes are to provide a means of identifying the completion of special reports and services that are an adjunct to the basic service rendered. The code descriptor for 99025 says, Initial (new patient) visit when starred (*) surgical procedure constitutes major service at that visit.

An example of this situation would be the case of the woman who is sent to an ob/gyn only for the incision and drainage of a Bartholins gland abscess (56420*). Another example, suggested by a reader, is a patient sent by a primary care physician to the ob/gyn for a onetime visit for an amniocentesis (59000*).

Consultants have mixed reviews on whether or not ob/gyn practices should use code 99025. Thomas Kent, CMM, former practice manager of a five-provider ob/gyn office and current principal of Kent Medical Management of Dunkirk, MD, acknowledges that in recent months he has run into an increasing number of questions about this code but does not recommend its use unless a carrier asks for it. It boils down to what you are doing for the patient, he says. If you are looking to use 99025 merely for setting up a record for a new patient who is just having a procedure, then it doesnt apply. He points out that a radiologist doesnt code for setting up a record for a patient who visits just for a procedure. If you have legitimate work that you are doing for that patient in addition to the procedure, use the new patient code with a 25 modifier, he said.

Deb Lief, CPC, president of the North Texas chapter of the AAPC and manager of coding compliance for ProMedCo of Fort Worth, TX, says she has used the 99025 code and has begun to see it being used more by practices. However, she recommended checking with your carrier because reimbursement will vary. Becky Dawson, CPC, a compliance education specialist for the Department of Surgery Corporation of Columbus, OH, also cautions in using this code, and says it is never covered by Medicare. She also says, if you bill for an E/M service [when doing a starred procedure], you must be sure that it is significant and separately identifiable.

Finally, in checking with ACOGs Department of Coding and Nomenclature, Melanie Witt, RN, CPC, MA, says, ACOG advises people not to use this code, She went on to explain that the origin of the code was to try and bridge the gap between providing a full E/M service and just doing a procedure, but that few carriers will pay for it. Presumably, the code was designed to reflect the small amount of time a physician might spend talking to the patient or performing a limited examination before doing the procedure.