Ob-Gyn Coding Alert

Also, consider new 2020 E/M codes bundled into the regular office E/M codes.

Before you apply your new HyCoSy Category III code alongside another procedure, you should pause and check your National Correct Coding Initiative (CCI) edits. The latest round applies a bunch of edits to this code, among others, which means you may find your claim in limbo if you don’t adhere to these changes.

We’ve broken down all the confusing edits, so you’ll have the full picture.

Key: You’ll see modifier indicators of “1” and “0” mentioned below. A modifier indicator of “1” means that you can apply a modifier (such as, 59, Distinct procedural service) if your physician’s documentation warrants it and bypass the edit. However, you cannot use a modifier to separate an edit that has an indicator of “0.”

Remember: “Modifier 59 and other CCI-associated modifiers should not be used to bypass a CCI edit unless the proper criteria for use of the modifier 59 are met,” says Mary I. Falbo, MBA, CPC, president and CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania, adds. “Documentation in the medical record must satisfy the criteria required by any CCI-associated modifier that is used.”

Focus on These 0567T and 0568T Edits

Do you remember your new Category III codes?

You should be reporting 0567T (Permanent fallopian tube occlusion with degradable biopolymer implant, transcervical approach, including transvaginal ultrasound) and 0568T (Introduction of mixture of saline and air for sonosalpingography to confirm occlusion of fallopian tubes, transcervical approach, including transvaginal ultrasound and pelvic ultrasound). These codes went into effect January 1. Remember: You should be using 0568T a lot, says Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico, as this code represents the work involved in both the HyCoSy and FemVue^® procedures.

CPT^® Notations: CCI took aim and applied a lot of edits to these new codes, but before you worry about remembering these edits, CPT^® 2020 added notations that say “(Do not report 0567T in conjunction with 58340, 58565, 74740, 74742, 76830, 76856, 76857)” and “(Do not report 0568T in conjunction with 58340, 74740, 74742, 76830, 76831, 76856, 76857).” Therefore, a lot of these edits shouldn’t be a big surprise.

First of all, CCI bundles 0567T and 0568T into 58340 (Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or hysterosalpin­gography) with a “0” indicator. That means you cannot separate this edit for any reason.

Code 0568T is bundled into 58345 (Transcervical introduction of fallopian tube catheter for diagnosis and/or re-establishing patency (any method), with or without hysterosalpingography) with a “1” indicator.

Codes 0567T and 0568T are bundled into 58356 (Endometrial cryoablation with ultrasonic guidance, including endometrial curettage, when performed) with a “1” indicator.

Code 0567T is bundled into 58565 (Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants), 58615 (Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach), 58671 (Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or Falope ring)) with a “0” indicator.

Code 0567T is also bundled into 74740 (Hysterosalpingography, radiological supervision and interpretation), all of the ob and gyn ultrasound codes (76801-76857), all carrying a “0” indicator expect for 76813 (nuchal translucency code) which has an indicator of “1.”

Finally, 0568T is bundled into all of the gyn ultrasound codes (76830-76857) with an indicator of “0.”

In those cases where 0567T is the primary code, the codes 57400, 57410, 58100, 74742 have been bundled with a “0” indicator and 57800, 58555 and 76998 have been bundled with a “1” indicator.

In those cases where 0568T is the primary code, the codes 57410 and 74742 have been bundled with a “0” indicator and 76998 with a “1” indicator.

Evaluate These New E/M Edits

Bundled into the E/M codes (99201-99215) are the new codes for health and well-being coaching (0591T-0593T) and the new health behavior assessment and intervention codes (96156-96171), the new codes for online digital evaluation (99421), and reviewing and report preparation with regard to patient submitted blood pressure readings (99474).

All of these bundled codes carry a modifier indicator of “1.”

Example: Suppose your ob-gyn reviews patient submitted blood pressure readings (99474) as well as a regular E/M visit (99201-99215). In this case, you’ll only report the regular E/M visit (99201-99215) unless the problem E/M service was separate and significant for the review of the blood pressure data. For instance, the patient came in with a complaint of vaginal bleeding, but was also concerned about her blood pressures readings for the past few weeks. In that case you would have to append a modifier 25 (Significant, Separately Identifiable E/M Service…) to the problem E/M service.

Finally, These Edits Are Good to Know

Although you may not report new nerve block anesthesia codes 64451 and 64454 often, you should note that CCI bundles these codes into most of the gynecological surgery codes. You’ll see a modifier indicator of “1.”