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Ob-Gyn Coding Alert

New Appendixes Make Genetic Modifiers a Snap

Published on Sun Jan 02, 2005

CPT includes 58823 with conscious sedation procedures

If you need a quick way to convert CPT codes to HCPCs codes, CPT provides an easy reference prior to coding - Appendix F. Make the most of CPT by learning about 2005's added appendixes. You'll be glad you did.
 
"I use Appendixes on a daily basis when I'm unable to remember a code or need to code a procedure that is unfamiliar to me," says Donna Kroening, CPC, reimbursement manager for the ob-gyn department at the Medical College of Wisconsin in Milwaukee.
 
"We use the CPT Appendixes quite a bit in our coding, especially because we code for multiple specialties," says Jan Lasker, CPC, billing supervisor of Oaktree Physicians Inc. in Middleburg Heights, Ohio. "The appendixes come in very handy. It's a quick reference for any CPT changes, definitions, and modifier questions."
 

  • Appendix F lists the CPT codes that are exempt from modifier -63 (Procedure performed on infants less than 4 kg). "Our ob-gyn doctors do not provide any services for newborns or infants, so we do not use modifier -63," Lasker says. "However, we do use Appendix F when we need to convert CPT codes to HCPCS codes."
     
  • Appendix G shows the procedures that include conscious sedation. CPT created a new symbol, to denote this for the individual codes. In the case of ob-gyn practices, you'll find 58823 (Drainage of pelvic abscess, transvaginal or transrectal approach, percutaneous [e.g., ovarian, pericolic]) listed in this Appendix as including this type of sedation.
     
  • Appendix H is an alphabetic index of the Category III code performance measures. The index lists them by clinical condition or topic. This Appendix includes a brief description of the performance measure and its source (that is, Physician Consortium for Performance Improvement or the National Committee on Quality Assurance [NCQA], Health Employer Data Information Set [HEDIS]).
     
  • Appendix I lists genetic testing code modifiers. You should report these with the molecular lab procedures related to genetic testing. CPT categorizes the modifiers by mutation - the first digit indicates the disease category, and the second denotes the gene type. For instance, 0A signifies testing for the BRCA1 gene that is a marker for hereditary breast or ovarian cancer.

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