Ob-Gyn Coding Alert

On Feb. 8, 2001, HCFA released Program Memorandum B-01-09, which temporarily suspends many of the edits in version 6.3 of the national Correct Coding Initiative (CCI). These edits bundled more than 800 procedural codes with evaluation and management (E/M) codes when they were issued last fall. The suspension of the unpopular coding edits is retroactive to Oct. 30, the date the 6.3 edits were issued.

The bundling of the E/M codes with diagnostic and radiological procedures had required coders to use modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) when the E/M service represented a separate and significant service. HCFA now wants to educate physicians and coders as to what separate and significant service means.

Although the version 6.3 edits had little impact on ob/gyn coders, if you submitted claims that were rejected due to the edits, you should revisit these. If modifier
-25 applies, resubmit the claims. Correct coding dictates that you cannot bill for a service that was not performed.

The temporary suspension means only that HCFA is giving you a chance to look at your claims again. Before using modifier -25, make sure the service is significant and separately identifiable from the procedure. HCFA is reviewing the edits and may reimplement many of them as early as July 1, 2001.

The HCFA memo went into effect on Feb. 12, 2001, and, with the exception of some ophthalmology codes, does not impact any of the more recent CCI Version 7.0 edits. The complete program memorandum can be found at www.hcfa.gov/pubforms/transmit/ B0109.pdf.