Ob-Gyn Coding Alert

The American Medical Associations 2001 CPT, released Nov. 1, contains several important changes for ob/gyn providers and their coders. Although the new and revised codes will not go into effect until Jan. 1, 2001, ob/gyn practices will want to be sure they are ready for the changes

This year CPT presents us with some minor revisions to the evaluation and management [E/M] section. There are also some very needed changes in the surgical and ultrasound sections, which will be of the most interest to ob/gyns, says Melanie Witt, RN, CPC, MA, former program manager for the American College of Obstetricians and Gynecologists (ACOG) department of coding and nomenclature and an independent coding educator. Additionally, there are changes to laboratory codes as well as some new modifiers that ob/gyns should be aware of.

Evaluation and Management Clarifications

In its introduction to the E/M guidelines, CPT has clarified that professional services when determining whether a patient is new or established to a practice must be face-to-face. Prior to this year, many payers strictly interpreted the definition of an established patient to mean a patient who had received any professional service in the past three years, Witt notes. Therefore, had a physician written a prescription for a patient whom he or she had not yet seen in the office, or had the physician talked to the patient on the phone prior to making an appointment (and this was documented in the record), many payers would claim that the patient was established to the practice. With this new clarification, providing either of these services would not prevent the physician or nonphysician practitioner (i.e., physicians assistant, nurse practitioner or certified nurse midwife) from billing a new patient visit when the patient first presents in the office for care.

The guidelines for use of critical care codes 99291 (critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and 99292 (... each additional 30 minutes [list separately in addition to code for primary service]) have once again been revised after an extensive reworking in 1999. The latest revision stresses that to bill critical care codes the physician must be caring for a patient with a high probability of imminent or life-threatening deterioration in his or her condition due to single or multiple vital organ system failure. In addition, treatment for the illness or condition must involve procedures that deal with the organ system failure or life-threatening complications. A physician may bill for critical care and other E/M services on the same service date, but may not count the time spent performing other separately reported services or procedures as critical care time. Although it may be rare that ob/gyns bill for critical [...]