Ob-Gyn Coding Alert

Hint: Pay attention to the modifier indicator before applying 59.

If you’re feeling confident about the latest National Correct Coding Initiative (CCI) edits that went into effect January 1, then you might want to think again. You’ve got some new ob-gyn specific edits with which you have to contend. Check out these vaginal mesh, uterine fibroid ablation, ultrasound, and G code edits..

Check Out These Vaginal Mesh Edits

The vaginal mesh add-on code +57267 is now bundled into the following codes:

• 57268 (Repair of enterocele, vagina approach [separate procedure]),
• 57270 (Repair of enterocele, abdominal approach [separate procedure]),
• 57280 (Colpopexy, abdominal approach),
• 57288 (Sling operation for stress incontinence [eg, fascia or synthetic]), and
• 57425 (Laparoscopy, surgical, colpopexy [suspension of vaginal apex]).

Each of the above-mentioned edit pairs carries a modifier indicator of “1,” meaning that you might be able to report both codes in an edit pair if you have sufficient documentation to support separate coding. “The edit can be overcome, if appropriate, with the use of modifier 59 (Distinct procedural service),” says Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting, Inc. in Lansdale, Pa. If so, you should append a modifier to the Column 2 code. This should be an exception and not the rule, and you’ll need supporting documentation to back your claim up.

Example: If a patient had both an A&P repair with the add-on mesh to shore up attenuated vaginal wall tissue, and a sling procedure for stress urinary incontinence at the same session, you could then add modifier 59 to code 57267 because the mesh is related to the A&P repair, which is a different site than the urethral sling procedure, says Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, N.M.

Comb Through These Numerous 58674 Edits

You’ve got to learn a bunch of new edits surrounding new code 58674 (Laparoscopy, surgical, ablation of uterine fibroid[s] including intraoperative ultrasound guidance and monitoring, radiofrequency).

Code 58674 is bundled into other codes: Code 58674 is bundled into all codes representing a hysterectomy and/or myomectomy: 58140, 58146, 58152, 58180, 58200, 58210, 58240, 58260, 58262, 58263, 58267, 58270, 58275, 58280, 58285, 58290, 58291, 58292, 58293, 58294, 58542, 58543, 58544, 58546, 58548, 58550, 58552, 58553, 58554, 58571, 58572, and 58573. These edits have a modifier indicator of “0.”

Codes are bundled into 58674: On the other hand, bundled into the new code 58674 are the following: 0071T, 0072T, 0213T, 0216T, 0228T, 0230T, 36591, 36592, 44005, 44180, 49320, 57410, 58541, 58570, 58660, 62320-62327, 64400-64450, 64461-64484, 64486-64495, 64505-64530, 69990, 96523, 99155-99157, 99446-99449. These edits cannot be broken under any circumstances, because they have a modifier indicator of “0.”

The codes bundled into 58674 with a modifier indicator of “1” are the following: 12001-12021, 12031-12057, 13100, 13101-13153, 36000, 36400-36410, 36420-36440, 36600, 36640, 37243, 43752, 50715, 51701-51703, 52000, 61650, 76940, 76942, 76970, 76998, 92012, 92014, 93000-93010, 93040-93042, 93318, 93355, 94002, 94200, 94250, 94680-94690, 94770, 95812-95822, 95829, 95955, 96360-96368, 96372, 96374-96377, 99211-99223, 99231-99239, 99241-99245, 99251-99255, 99291, 99292, 99304-99316, 99334-99350, 99374-99378, G0463, G0471.

“As this new procedure represents a myomectomy, the edits are logical as you should only code the extensive myomectomy procedure,” Witt says. “If your ob-gyn performs a hysterectomy, removal of fibroids is never an additionally allowed procedure. The additional edits represent the typical edits applied to other ob-gyn procedures such as those for lysis of adhesions, anesthesia services, and of others services that would typically be performed or included with a surgical procedure, when applicable.”

Amp Up Your Ultrasound Edits

Additionally, you have some new edits surrounding ultrasound codes 76970 (Ultrasound study follow-up [specify]) and 76998 (Ultrasonic guidance, intraoperative).

Code 76970 is bundled into:

• 59001 (Amniocentesis; therapeutic amniotic fluid reduction [includes ultrasound guidance]),
• 59012 (Cordocentesis [intrauterine], any method),
• 59015 (Chorionic villus sampling, any method),
• 59070 (Transabdominal amnioinfusion, including ultrasound guidance),
• 59072 (Fetal umbilical cord occlusion, including ultrasound guidance),
• 59074 (Fetal fluid drainage [e.g., vesicocentesis, thoracocentesis, paracentesis], including ultrasound guidance),
• 59076 (Fetal shunt placement, including ultrasound guidance),
• 59897 (Unlisted fetal invasive procedure, including ultrasound guidance, when performed) and
• All of the ob-gyn ultrasounds (76801-76857).

All of these edits have a modifier indicator of “1.”

Code 76998 is bundled into:

• 59000 (Amniocentesis; diagnostic),
• 59001,
• 59012,
• 59015, and
• 76814 (Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; each additional gestation [List separately in addition to code for primary procedure]).

All of these edits have a modifier indicator of “1.”

Don’t Miss These G Code Edit Additions

Bundled into all E/M services with a modifier indicator of “0” are the following codes:

• G0406 (Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth)
• G0407 (Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth)
• G0408 (Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth)
• G0425 (Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth)
• G0426 (Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth)
• G0427 (Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communi­cating with the patient via telehealth).

This means that if your ob-gyn sees a patient in the office (99201-99215) and later performs a telehealth consultation for the same patient on the same calendar date, you will only report the office E/M service.