Ob-Gyn Coding Alert

The promised 57284 reversal doesn't deliver as much relief as you may have hoped for as its applicability is virtually nil. Here's what Correct Coding Initiative (CCI) version 14.2, effective July 1, will let you do in terms of incontinence and subq infusion-E/M bundles. .

CCI makes good on its promise to remove two pesky stress incontinence bundles, as reported in "News You Can Use: Resubmit 57287-57288 Claims Due to CCI Error" in 2008 Ob-gyn Coding Alert, Vol. 11, No. 8.

This deletion removes 57287 (Removal or revision of sling for stress incontinence [e.g., fascia or synthetic]) and 57288 (Sling operation for stress incontinence [e.g., fascia or synthetic]) from the 57284 (Paravaginal defect repair [including repair of cystocele, if performed]; open abdominal approach) bundle.

"CCI promised to remove these two codes as bundles, but it is not the -great- thing everyone thinks it will be," warns Melanie Witt, RN, CPC-OBGYN, MA, an ob-gyn coding expert based in Guadalupita, N.M.

Reason: You use 57284 for an abdominal approach -- which is an approach that ob-gyns hardly ever perform anymore, Witt explains.

Also, the edit that made 57287 a component was never an onerous bundle to begin with because it carried a modifier indicator of "1," Witt says. That meant if your ob-gyn removed a sling, you could bill 57284 and 57287 appended with modifier 59 (Distinct procedural service). That would tell the carrier the sling removal was unrelated to the paravaginal repair and qualifies as a separate incision/excision, Witt says.

Bigger change: Last year, CPT created new code 57285 (- vaginal approach), and CCI did not add 57287 or 57288 as components. This means you can report these codes together. This is good news because the vaginal paravaginal repair and sling for stress incontinence are common procedures physicians perform together, Witt says.

Secondly, CCI throws 90769 (Subcutaneous infusion for therapy or prophylaxis [specify substance or drug]; initial, up to one hour, including pump set-up and establishment of subcutaneous infusion site[s]) into a vast number of E/M services.

Note: All the new edits mentioned below have a modifier indicator of "1," meaning you can use a modifier to bypass the bundles provided you have supporting documentation. For edits involving E/M services, you-ll need to use modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

You should now consider 90769 bundled into the following E/M services: 99218-99220 (initial observation care), 99221-99223 (initial inpatient care), 99231-99233 (subsequent hospital care), 99234-99236 (same day admission and discharge from observation of inpatient), 99238-99239 (hospital discharge management), 99251-99255 (inpatient consultations) and 99281-99285 (ER care).

Translation: "Allowing the modifier is basically saying you can use modifier 59 if the observation or consult or nursing home visit is done at a different time than the infusion," says Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J. "I would recommend that times be put in the chart for the E/M and for the infusion to solidify the claim of separate times -- and separate times does not mean five or 10 minutes apart," Cobuzzi says.

Impact: Even though your ob-gyn probably does not personally perform the subcutaneous infusion at the E/M service, pay attention to this edit if ancillary staff performs the procedure. If you bill the infusion under the provider's number, do not expect separate reimbursement for the infusion with any of the above E/M services, due to the new CCI bundle.