Ob-Gyn Coding Alert

Question: I saw that CMS released the Correct Coding Initiative (CCI) edits version 15.2. Are there any edits that will affect my ob-gyn practice?

Georgia Subscriber

Answer: You have only one bundle to start applying as of July 1.

You should now consider +96376 (Therapeutic,prophylactic, or diagnostic injection [specify substance or drug]; each additional sequential intravenous push of the same substance/drug provided in a facility [List separately in addition to code for primary procedure]) a part of +58110 (Endometrial sampling [biopsy] performed in conjunction with colposcopy [List separately in addition to code for primary procedure]) as well as all of the delivery codes (59400-59622).

Rationale: Code +96376 is an add-on code that you can bill only with an initial IV push drug. For instance, you'll see that CCI already bundles 96374 (... intravenous push, single or initial substance/drug) and +96375 (...each additional sequential intravenous push of a new substance/drug) into 58110 and 59400-59622. This change merely adds an additional "add-on" code to the already bundled code family.

This edit carries a modifier indicator of "1," which means you can separate this edit with an appropriate modifier (such as 59, Distinct procedural service) if the criteria for doing so are met.