Reader Question: C-section and Hysterectomy   (February 2000)

Question: A C-section was done, and the patient had a hysterectomy with a left salpingo-oophorectomy. Should I code 59510 (routine obstetric care including antepartum care, cesarean delivery and postpartum care) (the patient rendered her care with our practice), plus 59525 (subtotal or total hysterectomy after cesarean delivery) with 58720-59 (salpingo-oophorectomy, complete or partial, unilateral or bilateral [separate procedure] [distinct procedural service]), or, should I code 59510 and 58150 (total abdominal hysterectomy [corpus and cervix], with [...]

Reader Question: Coding E/M Services   (February 2000)

Question: An ob patient comes in for a routine visit. During the course of her visit, she complains of sciatica. How would you code this visit? Do I code for an evaluation and management (E/M) visit or is this part of her prenatal visit?Alicia JohnsonDrs. Esposito, Mayer, Hogan & Assoc., P.A. Columbia, Md. Answer: Any time a physician has performed a significant and separately identifiable E/M service at the time of other services, the E/M service [...]

Reader Question: Counseling   (February 2000)

Question: For CPT codes 59410 (vaginal delivery only [with or without episiotomy, and/or forceps]; including postpartum care) and 59515 (cesarean delivery only; including postpartum care), are birth control counseling and prescribing and sterilization counseling included if the counseling occurs within the six-week postpartum period? Gary Yochim, D.O. Leitchfield, Ky. Answer: Some commercial insurance companies might consider payment for preventative care services for counseling coded 99401-99404 (preventative medicine counseling and/or risk factor reduction intervention[s] provided to an [...]

Reader Question: Coding a Pre-op Visit   (February 2000)

Question: For 58671 (laparascopy, surgical; with occlusion of oviducts by device [e.g., band. clip or Falope ring]), is the pre-op visit considered part of the surgical package? Gary Yochim, D.O.Leitchfield, Ky. Answer: Typically, you may bill the preoperative visit in which the decision to perform the procedure was made. Other visits performed prior to the procedure for obtaining informed consent and other administrative functions should not be billed. Sources for answers to reader questions: Melanie Witt, [...]

Reader Comment   (February 2000)

Lisa Lorence, a medical billing specialist at the Toledo (Ohio) Clinics department of obstetrics and gynecology offered a comment on one of our reader questions from the October 1999 Ob-Gyn Coding Alert. In the question, a laparoscopic procedure was 90 percent completed, then the doctor had to change to an open procedure. The reader asked whether modifier -53 (discontinued procedure) should be used to indicate the change mid-procedure. We answered that the -53 modifier is [...]

Overcoming the Reimbursement Challenges of the Diabetic Ob Patient   (January 2000)

Pregnancy with diabetes as a complicating factor requires that extra monitoring and often additional procedures be conducted by the ob-gyn. Two to three percent of all pregnancies have diabetes as a complicating factor, with more than 90 percent of these occurring as gestational diabetes. When managing either gestational or preexisting diabetes in the pregnant patient, additional care and monitoring are required to ensure a safe and relatively routine pregnancy and delivery. But to hear coding [...]

You Be the Coder: Consultation and Endocervical Curettage   (January 2000)

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.Question: A primary-care physician refers a patient to our ob-gyn office for an endocervical curettage. How do we bill for both the new patient consultation and the procedure on the same day? Do we just bill for new patient visit (99205-25) and 57505?Anonymous Michigan Subscriber

Answer: You should bill as you have outlined, using 99205 (office [...]

Optimize Reimbursement with Appropriate Level of Service Code   (January 2000)

Determining the level of an evaluation and management (E/M) visit and coding appropriately to that level will maximize reimbursement. But making these determinations can be complex. Melanie Witt, RN, CPC, MA, and former program manager of the department of coding and nomenclature at the American College of Obstetricians and Gynecologists (ACOG) has provided us with a thorough explanation of the criteria for determining E/M levels. This discussion is limited to office or other outpatient services [...]

Reader Question: Repair of Lacerated Ovary   (January 2000)

Question: What is the correct code for repair of a lacerated ovary? After an exploratory laparotomy, the patient was found to have a ruptured corpus luteum cyst. There was no cyst removed because it had already ruptured. I cannot find a code for the repair of the ovary. Annette BrehlMichigan Physician ServicesBloomfield Hills, Mich. Answer: Submit this procedure using 58999 (unlisted procedure, female genital system [non-obstetrical]) and include documentation of what was done. You should value [...]

Reader Question: Medicare Reimbursement for Pap Smears   (January 2000)

Question: In the August 1999 issue (page 62) of Ob-Gyn Coding Alert, an article on Reimbursement and Coding Tactics for Pap Smears states that according to HCFA guidelines, when a Medicare patient presents for her Pap smear, pelvic and breast exam, the service can be billed to Medicare using HCPCS Q0091 (collecting for Pap smear specimen) and G0909 (performing the pelvic and clinical breast examination). This information conflicts with the information in Medicares Local Medical Review [...]