Ob-Gyn Coding Alert

The latest version of the National Correct Coding Initiative (NCCI) contains 55 new edits that will impact ob-gyn practices, and all but five of these edits will never be paid by Medicare when they are billed together.

NCCI version 9.1 went into effect April 1. Although the number of edits that will impact ob-gyn practices is not extensive this time, most of them represent services that Medicare will never pay for when billed together (which is denoted in NCCI by a 0"" payment indicator)" says Melanie Witt RN CPC MA an ob/gyn coding expert based in Fredericksburg Va. "The new version also provides some extensive 'house cleaning'by deleting existing edits for codes that are no longer valid for claims processing " Witt says.

NCCI Takes on Surgical Procedures

The good news is that there are no new mutually exclusive code edits in NCCI 9.1. When NCCI labels a bundle as mutually exclusive Medicare will pay only for the lower-valued code of the two.

Consequently the 55 new edits are all of the comprehensive/component variety. The five new surgical bundles that allow you to use a modifier (for example -59 Distinct procedural service) to bypass the edit are listed in the table in article 11.

The 50 remaining bundles that Medicare will never pay when reported together (they have a "0" payment indicator) include the following:

1. You will never be paid for 56820 (Colposcopy of the vulva) when you bill it with 56501 (Destruction of lesion[s] vulva; simple [e.g. laser surgery electrosurgery cryosurgery chemosurgery]) 56633 (Vulvectomy radical complete) or 56805 (Clitoro-plasty for intersex state).

2. Do not bill 57061 (Destruction of vaginal lesion[s]; simple [e.g. laser surgery electrosurgery cryosurgery chemosurgery]) with 57421 (Colposcopy of the entire vagina with cervix if present; with biopsy[s]).

3. You cannot submit 57100* (Biopsy of vaginal mucosa; simple [separate procedure]) with 57421.

4. Medicare will deny 57420 (Colposcopy of the entire vagina with cervix if present) if you bill it with any of the following 18 procedure codes:

57155 Insertion of uterine tandems and/or vaginal ovoids for clinical brachytherapy

57220 Plastic operation on urethral sphincter vaginal approach (e.g. Kelly urethral plication)

57230 Plastic repair of urethrocele

57454-57461 Colposcopy of cervix procedures

57531 Radical trachelectomy with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling biopsy with or without removal of tube(s) with or without removal of ovary(s)

58145 Myomectomy excision of fibroid tumor(s) of uterus 1 to 4 intramural myoma(s) with total weight of 250 grams or less and/or removal of surface myomas; vaginal approach

58275-58294 Vaginal hysterectomy procedures.

5. NCCI 9.1 now permanently bundles 57421 into 57454* (Colposcopy of the cervix including upper/adjacent vagina; with biopsy[s] of the cervix and endocervical curettage).

6. Code 57454 is bundled into eight codes:

57220

57230

57420

57531

58145

58275-58285.

7. You cannot report 57455 ( with biopsy[s] of the cervix) with 57421.

8. The new NCCI includes 58605 (Ligation or transection of fallopian tube[s] abdominal or vaginal approach postpartum unilateral or bilateral during same hospitalization [separate procedure]) 58700 (Salping-ectomy complete or partial unilateral or bilateral [separate procedure]) 58740 (Lysis of adhesions [salpin-golysis ovariolysis]) and 58900 (Biopsy of ovary unilateral or bilateral [separate procedure]) with 58146 (Myomectomy excision of fibroid tumor[s] of uterus 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 grams abdominal approach).

In addition NCCI 9.1 changes the payment indicators for several codes so Medicare and those carriers that adhere to NCCI will never pay for colposcopies and other procedures performed in the same body area regardless of whether you append a modifier to the code says Terry Tropin RHIA CPC CCS-P manager of coding education for the American College of Obstetricians and Gynecologists (ACOG). These changes are retroactive to January 2003. For example Medicare now will never pay for 56820 (Colposcopy of the vulva) when you report it with 56515 (Destruction of lesion[s] vulva; extensive [e.g. laser surgery electrosurgery cryosurgery chemosurgery]). Likewise you will no longer be paid for 57420 (Colposcopy of the entire vagina with cervix if present) when you also bill 57022 (Incision and drainage of vaginal hematoma; obstetrical/postpartum) or 57023 ( non-obstetrical [e.g. post-trauma spontaneous bleeding]).

Ob Procedures Also Take a Hit

NCCI 9.1 officially and permanently bundles 59300 (Episiotomy or vaginal repair by other than attending physician) into the delivery codes (59400-59410 59510-59515 59610-59614 and 59618-59622). "These new bundles match the CPT prohibition from billing this procedure when performed by the physician who did the delivery " Witt says.

The new edits also bundle 59414 (Delivery of placenta [separate procedure]) into 59515 (Cesarean delivery only; including postpartum care). "The addition of this code bundle corrects an oversight as code 59414 had already been permanently bundled into all of the other delivery codes " Witt explains.

Ultrasounds Now Include Catheter Placement

The new edits also bundle 51701 (Insertion of non-indwelling bladder catheter [e.g. straight catheterization for residual urine]) and 51702 (Insertion of temporary indwelling bladder catheter; simple [e.g. Foley]) into each of the obstetrical and nonobstetrical ultrasound codes (76805-76857). You can override these bundles with modifier -59 however if the ob-gyn's documentation shows that the bundled procedure was unrelated to the reason for doing the ultrasound Witt says.

Don't Bill HCPCS Separately From Pap Smears

"Medicare has finally officially bundled their HCPCS alphanumeric codes into the CPT codes for Pap smear interpretations " Witt notes. "These code bundles will never be paid together because they each represent essentially the same procedure with the CPT codes representing a diagnostic Pap interpretation and the HCPCS codes representing the screening Pap interpretation." These code bundles are as follows:

NCCI 9.1 bundles G0123 (Screening cytopathology cervical or vaginal [any reporting system] collected in preservative fluid automated thin layer preparation screening by cytotechnologist under physician supervision) into 11 of the CPT Pap smear interpretation codes (88143-88154 and 88164-88167).

You should not report G0143 (Screening cytopathology cervical or vaginal [any reporting system] collected in preservative fluid automated thin layer preparation with manual screening and rescreening by cytotechnologist under physician supervision) G0144 (Screening cytopathology cervical or vaginal [any reporting system] collected in preservative fluid automated thin layer preparation with screening by automated system under physician supervision) G0145 (Screening cytopathology cervical or vaginal [any reporting system] collected in preservative fluid automated thin layer preparation with screening by automated system and manual rescreening under physician supervision) G0147 (Screening cytopathology smears cervical or vaginal performed by automated system under physician supervision) and G1048 (Screening cytopathology smears cervical or vaginal performed by automated system with manual rescreening) with 12 of the CPT Pap smear codes (88142-88154 and 88164-88167). In addition NCCI has bundled G0147 into +88141 (Cytopathology cervical or vaginal [any reporting system]; requiring interpretation by physician [list separately in addition to code for technical service]).

The new edits now include P3000 (Screening Papanicolaou smear cervical or vaginal up to three smears by technician under physician supervision) in the seven laboratory codes (88143-88148 88153-88154 88165 and 88167).

But Don't Forget About the Deletions

Although NCCI adds several edits with version 9.1 it also provides several deletions. "Anumber of the new 2003 colposcopy codes that were bundled into other procedures are no longer bundled by NCCI " Tropin emphasizes. "ACOG's coding committee worked very hard to make this happen."

These deleted bundles include colposcopy codes from NCCI version 9.0 bundled into other procedures performed in other body areas. NCCI 9.1 not only deleted these edits but removed them retroactively to January 2003. For example Tropin says NCCI no longer bundles 56820 with 57061 and 57065 (Destruction of vaginal lesion[s]; extensive [e.g. laser surgery electrosurgery cryosurgery chemosurgery]). Similarly you can now report 57100 with 56820.