Ob-Gyn Coding Alert

Follow-up inpatient consults are out; find out what you should report instead

On Jan. 1, you-ll have to alter the way you report vaginal grafts, endometrial biopsies, and inpatient consultations.

Familiarize yourself with these 2006 CPT changes now and prepare for smooth sailing in 2006.

Revise How You Code Vaginal Grafts

If you-ve been reporting vaginal graft revision using 58999 (Unlisted procedure, female genital system [nonobstetrical]), get ready to use a brand-new code. CPT has added 57295 (Revision [including removal], vaginal approach).

Example: Your ob-gyn performs surgery on a patient for prolapse, which requires a vaginal graft during the repair. You report this procedure using one or more of the following codes:

- add-on code +57267 (Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site [anterior, posterior compartment], vaginal approach [list separately in addition to code for primary procedure]) 

- colporrhaphy codes (57240-57265)

- rectocele repair code 45560 (Repair of rectocele [separate procedure])

- abdominal approach colpopexy code 57280 (Colpopexy, abdominal approach).

The surgery, however, results in a complication with a graft, and your ob-gyn has to go back to revise the graft.

In the past: -While we have a code for the revision of a sling procedure for stress urinary incontinence, the only way to report the revision of a vaginal graft was to use 58999,- says Melanie Witt, RN, CPC, MA, an independent coding consultant in Guadalupita, N.M.

In 2006: As of Jan. 1, you-ll be able to use new code 57295 instead.

Enter the New Endometrial Biopsy Code

Another new code you-ll have in 2006 is an add-on code for endometrial biopsies: +58110 (Endometrial sampling [biopsy] performed in conjunction with colposcopy [list separately in addition to code for primary procedure]).

Example: The ob-gyn, when performing a colposcopy, wants to perform an endometrial biopsy in addition to any cervical or vaginal biopsy.
 
In the past: If you tried to report the endometrial biopsy code 58100 (Endometrial sampling [biopsy] with or without endocervical sampling [biopsy], without cervical dilation, any method [separate procedure]), most carriers would deny your claim. The National Correct Coding Initiative bundles this procedure with all colposcopy codes that include a vaginal or cervical biopsy (57421, Colposcopy of the entire vagina, with cervix if present; with biopsy[s]; and colposcopy of the cervix codes 57454-57461).

In 2006: -The new code, 58110, takes care of this problem because the resource-based relative value system (RBRVS) values this code for the intra-service work only,- Witt says.

Bonus: When you receive your 2006 CPT book, you-ll find that CPT added notes under colposcopy codes 57420 (Colposcopy of the entire vagina, with cervix if present), 57421 (- with biopsy[s]) and 57452-57461. These notes indicate that if the ob-gyn also performs an endometrial biopsy, you should report 58110 in addition to the colposcopy code. Remember that 58110 is an add-on code, so you don't need a modifier when you report this code with one of the colposcopy codes.

Keep in mind: Because of the addition of 58110, CPT has also revised 57421 to clarify that it represents only a biopsy of the vagina and/or cervix and not an endometrial biopsy. Now when you look at the descriptor of 57421, you-ll see: - with biopsy[s] of vagina/cervix.

Toss the Confirmatory Consult Codes

In addition to vaginal grafts and endometrial biopsies, you-ll have to be careful when you-re preparing to report a consultation, because your consultation coding choices just got narrower. In 2006, you-ll no longer have the option of reporting confirmatory consultations (99271-99275).
 
But that doesn't mean that this deletion should be unwelcome. -You couldn't use confirmatory consultation codes when counseling or coordination of care dominated the visit,- Witt says, -even though such consultations normally involved face-to-face counseling with the patient rather than a physical examination.-

-We haven't used these codes much over the past few years,- says Peggy Stilley, CPC, office manager for Women's Healthcare Specialists, an Oklahoma University-based private ob-gyn practice in Tulsa. -When our payers request a confirmatory consultation, they simply apply their own medical review and authorization process to regular E/M codes instead.-

Important: As of Jan. 1, if your ob-gyn sees a patient for a confirmatory consultation, you should report an inpatient or outpatient E/M code, not a consultation code.

-The reason is a confirmatory consultation is requested by the patient, rather than at the request of a qualified healthcare provider,- Witt says. Think of it this way: -We-ve been referring to confirmatory consults as -second opinions,- - Stilley says.

Don't forget: If a third party requests this second opinion to confirm, for example, that the ob-gyn's recommendation for surgery was medically indicated, you should add modifier 32 (Mandated services) to the E/M code.

Strike Out Follow-Up Inpatient Consults Too

Along the same line as the confirmatory consult deletion, you-ll also discard the follow-up inpatient consultation codes (99261-99263). CPT guidelines now instruct the physician to report the subsequent hospital care codes (99231-99233) if the patient requires a follow-up visit after the initial inpatient consultation.
 
Good news: -This change is a positive one for ob-gyn practices because the relative value units (RVUs) for the hospital care codes are slightly higher than the follow-up consultation codes were,- Witt says. 
 
Note this comparison for 2005 RVUs:  See the chart at the top of the page.