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Ob-Gyn Coding Alert

CCI Update:
Version 9.0 Incorporates New Codes and New Edits for Ob-Gyns

The Correct Coding Initiative (CCI), which took effect Jan. 1, includes some minor additions to many of the existing code bundles for ob-gyn procedures, but with 38 new code additions to CPT 2003 that ob-gyn practices may report, the number of new edits seems daunting.

To get a handle on the number of edits, first understand that the bundled code edits for the new procedure codes will not take effect until March 1, when Medicare will begin to process claims with these codes. Watch New Edits for Existing Codes "In addition to the new CPT code edits, there are 1,365 code edits that may impact ob-gyn practices, and 15 of those edits are considered to represent mutually exclusive procedures," says Melanie Witt, RN, CPC, MA, an ob-gyn coding expert based in Fredericksburg, Va. (For more on mutually exclusive procedures, see the box on page 12.)

Most of the changes to the code bundles affecting the female-genital-system chapter codes include some combination of the following codes: 51701 Insertion of non-indwelling bladder catheter (e.g., straight catheterization for residual urine) 51702 Insertion of temporary indwelling bladder catheter; simple (e.g., Foley) 51703 complicated (e.g., altered anatomy, fractured catheter/balloon) 56820 Colposcopy of the vulva 57420 Colposcopy of the entire vagina, with cervix if present 64416 Injection, anesthetic agent; brachial plexus, continuous infusion by catheter (including catheter placement) including daily management for anesthetic agent administration 64430* pudendal nerve 64435* paracervical (uterine) nerve. In some cases, the new CCI bundles only 51701 and 51702, in others it bundles 51701-51703, and in still others it includes all of the above-listed codes. "The majority of the time, however, each of these codes, when bundled, does not allow a modifier to bypass the edit," Witt says. For instance, you can bypass the edit when the colposcopy codes are bundled in the vulvar procedures, but cannot do so when they are bundled  into vaginal procedures. You can use a modifier to bypass these new edits only when bundled into the following comprehensive codes: 56405-56441, 56515-56605, 56620-56632, 56634-56800, 56810, 57023, 57287, 59400, 59410, 59510, 59515, 59610, 59614, 59618 and 59622. Version 9.0 also bundles several procedures into the hysterectomy codes (58150-58285) and added a large number of bundled procedures to the codes used to report ovarian, tubal and peritoneal cancer surgery (58950-58960). "The good news is that you can bypass almost all of these bundled procedures with a modifier if they are shown to be 'distinct,'" Witt explains. Medicare, however, will never pay separately for the myomectomy code (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) when bundled. Selected additional code pairs that cannot be [...]

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