Ob-Gyn Coding Alert

Remember: Check your modifier indicator before tacking on modifier 59

If you-ve acquainted yourself with all of CPT 2006's new ob-gyn-related codes, your work is only half done, thanks to a slew of new edits in the National Correct Coding Initiative (NCCI), version 12.0.

You don't have any time to waste learning these edits because they took effect Jan. 1.

How 44180 Takes the Brunt of New Edits

You-re likely to see a lot of denials revolving around the new code 44180 (Laparoscopy, surgical, enterolysis [freeing of intestinal adhesion] [separate procedure]) because of NCCI 12.0.

First, NCCI indicates that when your ob-gyn performs 44180, you should forgo reporting the following codes separately:  

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Column 1  
   
44180   

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Column 2

36000, 36410, 37202, 43752, 44701, 49320, 62318, 62319, 64415-64417, 64450, 64470, 64475, 69990, 90760, 90765, 90772, 90774, 90775, C8950, C8952 

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Catch this: You can use a modifier to separate the edits for all of these combinations -- except when your ob-gyn performs 44180 and 49320 (Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) or 44180 and +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]).

In both of these situations, you-ll find a modifier indicator of -0,- meaning you cannot separate this edit under any circumstances. Result: If you try to report 44180 and 49320 or 44180 and 69990 separately, you-ll receive a denial and only be reimbursed for 44180, says Melanie Witt, RN, CPC-OGS, MA, an ob-gyn coding expert based in Guadalupita, N.M.

On the other hand, NCCI 12.0 also makes 44180 a component code to many other procedures. The following edits have a modifier indicator of -0-:

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Do Not Separate These Edits 

Column 1        

44005, 44970, 49321, 49322, 51990, 51992, 57280, 57283, 57425, 58150, 58545-58554, 58660-58662, 58670-58673, 58740, 58940, 58953-58956  

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Column 2 

44180 

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Example: If your ob-gyn performs 58550 (Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 grams or less) and the work represented by 44180, you should report only 58550. Medicare, and payers that follow Medicare's guidelines, will not pay for 44180 if you tried to report it separately.

NCCI 12.0 also bundles 44180 with other procedures but allows you to bypass the edit if your documentation meets the criteria. These edits have a modifier of -1-:

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You Can Separate These Edits If Necessary 

Column 1 

57270, 57282, 57305, 57307, 57540, 57545, 58140, 58146, 58152-58240, 58400-58540, 58600-58615, 58700, 58720, 58750-58770, 58805, 58822, 58825, 58900-58925, 58943-58952, 58960, 59100-59140, 59325, 59350, 59510-59515, 59620, 59622, 59857

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Column 2  

44180

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Example: If your ob-gyn performs a colporrhaphy (57270, Repair of enterocele, abdominal approach [separate procedure]) as well as a laparoscopic enterolysis (44180), you could report both codes, adding modifier 59 (Distinct procedural service) to 44180. Just make sure your ob-gyn's documentation shows that he performed the posterior colporrhaphy and the laparoscopic enterolysis through different incisions.

-Remember it's OK to use the 59 modifier if documentation warrants the need,- says Annette Grady, CPC, CPC-H, an independent healthcare consultant and AAPC officer on the National Advisory Board in Bismarck, N.D. -Since 59 has been under OIG scrutiny, many are fearful of utilization of this modifier. The key is that no two patients are the same, and there are always circumstances that warrant a different procedure or service due to special circumstances.-

Heed These Other New Code Edits

Code 44180 wasn't the only new CPT code slammed with NCCI 12.0's edits. You should also take care when you report these new codes:
 
- 45990 -- Anorectal exam, surgical, requiring anesthesia (general, spinal, or epidural), diagnostic

- 57295 -- Revision (including removal) of prosthetic vaginal graft, vaginal approach

- +58110 -- Endometrial sampling (biopsy) performed in conjunction with colposcopy (list separately in addition to code for primary procedure).

The following chart shows what codes you shouldn't try to report separately. Those with a -*- by them mean that you cannot bypass the edits with a modifier, no matter the situation. In all other cases, you can -- as long as you meet the criteria for doing so.

See chart upper right corner.

Example: If your ob-gyn performs 57295 as well as the work represented by 00940 (Anesthesia for vaginal procedures [including biopsy of labia, vagina, cervix or endometrium]; not otherwise specified), you should only report 57295. This shouldn't come as a huge surprise because 00940 represents an anesthesia service. Medicare never pays the operating surgeon for performing anesthesia. Remember, in this chart, the -*- by an edit shows that you cannot bypass it, even if you have a modifier.

On the other hand, if your ob-gyn schedules an office colposcopy and performs the add-on procedure 58110, and the ob-gyn also gives the patient her monthly injection of Depo-Provera for contraception during this encounter, you can bill 90772-59 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) plus the medication (J1055, Injection, medroxyprogesterone acetate for contraceptive use, 150 mg). The reason you can separate this edit with a modifier is that this situation constitutes two procedures in different anatomic sites.

Bonus: NCCI 12.0 also bundles the two new codes for conversion of a basic ultrasound to 3-D (76376, 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; not requiring image postprocessing on an independent workstation; and 76377, - requiring image postprocessing on an independent workstation) into the following services:

- biophysical profile codes 76818 (Fetal biophysical profile; with non-stress testing) and 76819 (... without non-stress testing), and

- fetal Doppler codes 76827 (Doppler echocardiography ... complete) and 76828 (... follow-up or repeat study).

The assigned indicator is -1,- so if you meet the criteria for reporting the 3-D separately with the appropriate modifier, you can bypass the edit, Witt says. Medicare has indicated that the reason for the bundle is -misuse of column two code with column one code.- But in any case, you would never convert these two procedures into a 3-D format, Witt adds.

One last edit: NCCI 12.0 bundles 44320 (Colostomy or skin level cecostomy) into 57307 (Closure of rectovaginal fistula; abdominal approach, with concomitant colostomy). You can use an appropriate modifier to bypass this edit.