CPT 2007 Broadens Choices for OB/GYN Coders
By Rhonda Buckholtz, CPC
The 2007 CPT codes offer OB/GYN coders many new choices, although some may take a little time to get to know their way around.
On the upside, the American Medical Association (AMA) increased options for coding hysterectomies with five new codes (58541-58544, 58548) that represent the less invasive laparoscopic approach. A new code in the medicine section recognizes the work of genetic counselors (non-physician) associated with the occurrence or the risk of a genetic disorder occurring within the family. On the other hand, the reorganization of the breast mammography and bone/joint studies codes might require some time to get used to their reorganization in the CPT manual. A new Category II code (3014F) is a clinical performance benchmark for screening mammography.
Coding for hysterectomies requires a close look at documentation. The new laparoscopic codes require the measurement of the uterus in grams and whether the tubes and ovaries were removed during the procedure. Code 58541 reports the procedure for a uterus 250 grams or less, while code 58543 reports a uterus greater than 250 grams in weight. The subordinate codes report the removal of tubes and ovaries. The same applies to existing open procedure codes 58260-58270 (250 grams or less) and 58290-58294 (greater than 250 grams).
Compared to open hysterectomy procedures (abdominal and vaginal), the laparoscopic procedure (supracervical) is done through small incisions in the abdomen; a large uterus can be cut into small pieces and passed down the vagina, along with the other tissue removed during the procedure. In a supracervical laparoscopic hysterectomy, the cervix is not removed. A laparoscopic hysterectomy typically requires a shorter recovery period than abdominal or vaginal procedures. The addition of the laparoscopic codes is a welcome relief to the OB/GYN provider, who, prior to this year, had few choices to adequately code the procedure. Many coders reported the unlisted procedure code, and submitted the unlisted code with extensive documentation to support the claim. Others used the existing laparoscopic-assisted hysterectomy code with a modifier 52 depending. The final choice ultimately came down to payer requirements and headaches for the physician offices trying to figure out the best approach to reimbursement.
CPT finally added a code in 2007 that reports the work of a trained genetic counselor. The code (96040), which is reported for each 30-minute face-to-face meeting with the family or patient, can be applied at the time a genetic anomaly is detected or to assess risk. For example, an adult with a family history of cystic fibrosis may want to discuss the potential of passing the condition on to future generations or the meeting with the genetic counselor may be held after the birth of a child with a genetic disorder to discuss everything from the medical facts to services available and the possibility of recurrence in future offspring. If a physician provides the counseling, use an evaluation and management code. The rather extensive write-up in the CPT 2007 Changes: An Insider’s View includes five clinical scenarios that apply to the code. Diagnosis codes that go in tandem with 96040 include:
V19.5 Family history, congenital anomalies (hereditary disease)
V26.33 Genetic counseling
Two new sections — Breast, Mammography (77051-77059) and Bone/Joint Studies (77071-77084) — shift codes from their former spot under the “Other Procedures” category. There should be no problem with comparing these codes to last year’s model since the new Appendix M crosswalks each of the deleted codes to their new place in the manual. Finally, the new Category II code is a performance benchmark for use in clinical practice. Appendix H lists the diseases associated with the particular codes; for example, code 3014F is a performance measurement correlated to a screening mammography.
Facts about a hysterectomy
- Hysterectomy is the second most common major operation performed in the United States, second only to cesarean section
- Approximately 600,000 American women have a hysterectomy every year, at a cost of almost $5 billion
- By the age of 60, one out of every three women in the United States has had a hysterectomy From the book “A Gynecologist’s Second Opinion,” by William H. Parker, M.D.