Ob-Gyn Coding Alert

Tip: Even if the modifier indicator is ‘1,’ you shouldn’t automatically apply a modifier.

If you weren’t paying attention, you might have missed the latest round of Correct Coding Initiative (CCI) edits. Version 22.3 went to effect on October 1. Here’s the ob-gyn related additions of note.

Include These Debridement Services into All Ob-Gyn Codes

The following codes have been bundled into all of the ob and gyn procedure codes, which means you need to pause before reporting the following debridement services:

• 11000-11005,
• 11042-11047, and
• 97597-97602.

Important: Each edit carries a modifier indicator of “1,” meaning you can use a modifier (such as 59, Distinct procedural service) to bypass the edit, if the criteria for doing so are met.

Example: For instance, a patient may have presented for removal of a vaginal foreign body due to an accident, but also has a large gash on the inner thigh that is infected and requires debridement. In this case, you can report codes 57145 (Removal of impacted vaginal foreign body (separate procedure) under anesthesia (other than local)) and 11042-59 (Debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq cm or less; Distinct procedure) (or if using the Medicare ‘X’ modifier, Modifier XS, Separate Structure, a service that is distinct because it was performed on a separate organ/structure).

Laparoscopic Biopsy is Now Part of Many Surgeries

In addition, you need to know chances are you shouldn’t be reporting 49321 (Laparoscopy, surgical; with biopsy [single or multiple]) with your ob-gyn’s surgical procedures. The reason is that CCI 22.3 bundles 49321 into many surgical codes.

While it carriers an indicator of “1,” meaning that a modifier could be used, keep in mind that “Medicare will not reimburse for a biopsy of an area which is then removed in part or in total,” says Melanie Witt, RN, MA,  an independent coding expert based in Guadalupita, N.M.

The primary surgery codes for this bundled are:

• all of the abdominal hysterectomy codes (58150, 58152, 58180, 58200, 58210),
• the pelvic extent procedure 58240,
• laparoscopic supracervical hysterectomy (58543-58544),
• laparoscopic myomectomy (58545-58546),
• laparoscopic radical hysterectomy (58548),
• LAVH (58552-58554),
• total laparoscopic hysterectomy (58570-58573),
• laparoscopic BSO (58661),
• open salpingectomy and BSO codes (58700-58720),
• ovarian cystectomy (58925),
• open oophorectomy (58940),
• malignancy resection codes (58943-58960),
• 58950, and
• ectopic pregnancy codes that include hysterectomy or salpingectomy/oophorectomy (59120, 59135, and 59151).

Example: Your ob-gyn performs a right ovarian cystectomy (58662, Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method) and takes a laparoscopic biopsy of a suspicious area on the same ovary (49321). In this case, you should only report 58662.

Apply 0437T to Colporrhaphy Codes

In addition, CCI 22.3 bundles code 0437T+ (Implantation of non-biologic or synthetic implant [e.g., polypropylene] for fascial reinforcement of the abdominal wall [List separately in addition to code for primary procedure]) into the colporrhaphy codes 57240-57265.

While this Category III code carries a modifier indicator of “1,” remember that you should code vaginal grafts using the add-on code 57267+ (Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site [anterior, posterior compartment], vaginal approach [List separately in addition to code for primary procedure]) instead, Witt says.

Lastly, Tack on 2 More Codes Bundling Cystoscopy

And finally, CCI 22.3 adds two more codes to the list of those that bundle cystoscopy (52000, Cystourethroscopy [separate procedure]):

• 51990 — Laparoscopy, surgical; urethral suspension for stress incontinence
• 51992 — Laparoscopy, surgical; sling operation for stress incontinence (eg, fascia or synthetic).

You can use a modifier to bypass the edit — but only if the criteria for doing so are met.