Ob-Gyn Coding Alert

Find out which edits are mutually exclusive and which won't allow a modifier Twenty-seven is the key number for this round of National Correct Coding Initiative (NCCI) edits. That's the number of ob-gyn-quot;related edits you-ve got to implement to your daily coding practice -- and sooner rather than later. They took  effect April 1. Pelvic Exam Code Hit Again Remember how NCCI version 13.0 slammed 57410 (Pelvic examination under anesthesia) with edits? NCCI 13.1 brings you a few more.

Many of the cystourethroscopy codes and the few remaining codes in the female genitourinary chapter that did not include this bundle already -- such as colpopexy (57283, Colpopexy, vaginal; intraperitoneal approach [uterosacral, levator myorrhaphy]) and vaginal graft revision (57295, Revision [including removal] of prosthetic vaginal graft; vaginal approach) -- now include the work involved with a pelvic exam under anesthesia (57410).

Watch out: CMS has placed a -0- indicator on these bundles. This means you cannot use a modifier to bypass the edit under any circumstance, says Melanie Witt, RN, CPC-OGS, MA, a coding expert based out of Guadalupita, N.M.

-This shouldn't be a big surprise, because payers always bundle an exam under anesthesia (EUA) when documented in an op report,- Witt says. Grapple With These Vaginal Graft Edits Second, when you prepare to report vaginal graft revision code 57295, you-ll need to take a few additional bundles into account.

Modifier indicator of -0-: NCCI edits now include catheter placement and perineoplasty codes 51701 (Insertion of non-indwelling bladder catheter [e.g., straight catheterization for residual urine]), 51702 (Insertion of temporary indwelling bladder catheter; simple [e.g., Foley]) and 56810 (Perineoplasty, repair of perineum, nonobstetrical [separate procedure]) with 57295. In other words, you should not try to report these procedures separately from a vaginal graft revision.

Modifier indicator of -1-: NCCI gives a modifier indicator of -1- to the following edits bundling procedures into 57295. These procedures include vaginal procedures for a biopsy (57100, Biopsy of vaginal mucosa; simple [separate procedure]), foreign-body removal (57415, Removal of impacted vaginal foreign body [separate procedure] under anesthesia), application of packing (57180, Introduction of any hemostatic agent or pack for spontaneous or traumatic nonobstetrical vaginal hemorrhage [separate procedure]), vaginal dilation (57400, Dilation of vagina under anesthesia) and vaginal and cervical colposcopy (57420, Colposcopy of the entire vagina, with cervix if present; and 57452, Colposcopy of the cervix including upper/adjacent vagina).

To separately report these procedures from the vaginal graft revision, you would append a modifier, such as 59 (Distinct procedural service), to the component procedure code to indicate to the payer that the billed procedures are distinct and separately identifiable, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, director of outreach programs at the American Academy of Professional Coders. [...]