Ob-Gyn Coding Alert

Correct Coding Initiative (CCI) version 8.3 makes an across-the-board change, bundling 11 injection codes into every comprehensive surgical code that did not already have them listed. The new code edits are effective Oct. 1. There are 1,916 new code bundles for gynecology codes and 616 new bundles for obstetric codes in CCI 8.3. Despite these numbers, there were no dramatic changes that should concern ob-gyn coders in general. A few mutually exclusive code bundles have been added, but none were deleted for codes that ob-gyn coders use. In addition, none of the changes to the "0" and "1" bypass indicators from the previous CCI version affected ob-gyn billing. 11 Injection Codes Now Included in Most Surgeries CCI 8.3 bundles 11 injection codes into every comprehensive surgical code: 36000* Introduction of needle or intracatheter, vein 36410* Venipuncture, child over age 3 years or adult, necessitating physicians skill (separate procedure), for diagnostic or therapeutic purposes. Not to be used for routine venipuncture 37202 Transcatheter therapy, infusion other than for thrombolysis, any type (e.g., spasmolytic, vasoconstrictive) 62318 Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic 62319 lumbar, sacral (caudal) 64415* Injection, anesthetic agent; brachial plexus 64417* axillary nerve 64450* other peripheral nerve or branch 64470 Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level 64475 lumbar or sacral, single level 90780 Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour. CCI bundled 36000, 36410 and 90780 because they are considered a standard of practice. The rest of the codes were added because they represent possible anesthesia services that would be included in the surgical procedure, if performed. Of course, all of these codes can be reported separately with the appropriate modifier if the physician believes that the service is distinct from or unrelated to the primary procedure. Version 8.3 includes additional edits that affect codes frequently reported by ob-gyn practices. For example, a limited pelvic and para-aortic staging lymphadenectomy (38562) has been bundled with the codes for resection of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy (BSO), omentectomy and radical debulking (58952) and a BSO with omentectomy, total abdominal hysterectomy (TAH) and radical debulking (58953). You cannot bypass this bundle by using a modifier.

"These changes will not greatly affect our ob-gyn physicians," says Socorro Ramon, coding educator for Ob Gyn Associates in Houston. Oncology physicians usually perform the lymphadenectomy portion of the surgery, while the practices ob-gyn surgeons do the gynecological portion, [...]