Reimbursement Advisor

Q Can I bill a nonstress test (NST) 59025 with TC (Technical component) as a modifier?

A A physician never uses the -TC modifier, even if he or she personally performed the NST. If this procedure is performed in the hospital, the -TC modifier is reported by the hospital for the use of the equipment.

The physician reports the service with modifier -26 (Professional component).

If the procedure is performed in the office setting and the physician owns the equipment, code 59025 is billed without modifiers, as it represents both technical and professional components.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Can I bill a nonstress test (NST) 59025 with TC (Technical component) as a modifier?

A A physician never uses the -TC modifier, even if he or she personally performed the NST. If this procedure is performed in the hospital, the -TC modifier is reported by the hospital for the use of the equipment.

The physician reports the service with modifier -26 (Professional component).

If the procedure is performed in the office setting and the physician owns the equipment, code 59025 is billed without modifiers, as it represents both technical and professional components.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Can I bill a nonstress test (NST) 59025 with TC (Technical component) as a modifier?

A A physician never uses the -TC modifier, even if he or she personally performed the NST. If this procedure is performed in the hospital, the -TC modifier is reported by the hospital for the use of the equipment.

The physician reports the service with modifier -26 (Professional component).

If the procedure is performed in the office setting and the physician owns the equipment, code 59025 is billed without modifiers, as it represents both technical and professional components.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q When a patient presents to the hospital for preterm labor and is seen within 23 hours, which observation codes are appropriate: 99217–99220 (Initial observation care with discharge on second day) or 99234–99236 (Observation or inpatient care services including admission and discharge on the same day)?

There is no designated area in our hospital for 99217–99220, if I understand the coding book correctly.

A The code choice depends on when the services took place.

No designated place in the hospital is required in order to bill the observation codes, but the physician should state in the record that the patient is being kept for observation.

If the patient is “admitted and discharged” from observation care on the same calendar date, you bill the codes 99234–99236. If she is admitted on day 1 and discharged on day 2, then go with the 99217–99220 codes. Some payers have a time requirement for you to be able to bill for observation care, but many do not. if you cannot bill for observation care, then the default is the outpatient E/M codes, 99201–99215.

Remember these requirements for observation care:

• The minimum documentation is a detailed history and detailed exam with any level of medical decision-making (straightforward, low, moderate, or high complexity). If you fail to document both at the minimum level, you cannot use an observation code.
  
• The physician must physically see the patient on the date of admission and discharge in order to bill for observation care.
  

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q When a patient presents to the hospital for preterm labor and is seen within 23 hours, which observation codes are appropriate: 99217–99220 (Initial observation care with discharge on second day) or 99234–99236 (Observation or inpatient care services including admission and discharge on the same day)?

There is no designated area in our hospital for 99217–99220, if I understand the coding book correctly.

A The code choice depends on when the services took place.

No designated place in the hospital is required in order to bill the observation codes, but the physician should state in the record that the patient is being kept for observation.

If the patient is “admitted and discharged” from observation care on the same calendar date, you bill the codes 99234–99236. If she is admitted on day 1 and discharged on day 2, then go with the 99217–99220 codes. Some payers have a time requirement for you to be able to bill for observation care, but many do not. if you cannot bill for observation care, then the default is the outpatient E/M codes, 99201–99215.

Remember these requirements for observation care:

• The minimum documentation is a detailed history and detailed exam with any level of medical decision-making (straightforward, low, moderate, or high complexity). If you fail to document both at the minimum level, you cannot use an observation code.
  
• The physician must physically see the patient on the date of admission and discharge in order to bill for observation care.
  

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q When a patient presents to the hospital for preterm labor and is seen within 23 hours, which observation codes are appropriate: 99217–99220 (Initial observation care with discharge on second day) or 99234–99236 (Observation or inpatient care services including admission and discharge on the same day)?

There is no designated area in our hospital for 99217–99220, if I understand the coding book correctly.

A The code choice depends on when the services took place.

No designated place in the hospital is required in order to bill the observation codes, but the physician should state in the record that the patient is being kept for observation.

If the patient is “admitted and discharged” from observation care on the same calendar date, you bill the codes 99234–99236. If she is admitted on day 1 and discharged on day 2, then go with the 99217–99220 codes. Some payers have a time requirement for you to be able to bill for observation care, but many do not. if you cannot bill for observation care, then the default is the outpatient E/M codes, 99201–99215.

Remember these requirements for observation care:

• The minimum documentation is a detailed history and detailed exam with any level of medical decision-making (straightforward, low, moderate, or high complexity). If you fail to document both at the minimum level, you cannot use an observation code.
  
• The physician must physically see the patient on the date of admission and discharge in order to bill for observation care.
  

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q One of our doctors saw a new patient in labor and delivery, and then she was seen in our office for a more extensive exam and ultrasound on the same day, but by a different doctor. Normally I would bill both with a -59 modifier (Distinct procedural service) assigned to an evaluation-and-management (E/M) code, but I was recently told that the -59 modifier should not be assigned to an E/M code. How should I bill for these 2 separate encounters?

A You are correct. While the modifier -59 may be assigned when a distinct and separate service was provided on the same date of service, such as when there is a separate patient encounter, the services referred to in the CPT guidelines are medicine and procedural services, not E/M services. An article in the American Medical Association’s CPT Assistant (January 1999) clarified that the modifier -59 may not be appended to E/M services.

If the patient is seen for the same reason and the physicians are considered the same under the payer’s rules, bill only 1 E/M service for that day, but take into account all of the care the patient received during both encounters to select the right E/M service level. The ultrasound, of course, will be billed as well.

If the payer allows more than 1 encounter on the same day, the second encounter in the office must be reported as an established patient service, since a new patient service applies to the first encounter that day.

There are no appropriate modifiers that can be added to the second E/M service.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q One of our doctors saw a new patient in labor and delivery, and then she was seen in our office for a more extensive exam and ultrasound on the same day, but by a different doctor. Normally I would bill both with a -59 modifier (Distinct procedural service) assigned to an evaluation-and-management (E/M) code, but I was recently told that the -59 modifier should not be assigned to an E/M code. How should I bill for these 2 separate encounters?

A You are correct. While the modifier -59 may be assigned when a distinct and separate service was provided on the same date of service, such as when there is a separate patient encounter, the services referred to in the CPT guidelines are medicine and procedural services, not E/M services. An article in the American Medical Association’s CPT Assistant (January 1999) clarified that the modifier -59 may not be appended to E/M services.

If the patient is seen for the same reason and the physicians are considered the same under the payer’s rules, bill only 1 E/M service for that day, but take into account all of the care the patient received during both encounters to select the right E/M service level. The ultrasound, of course, will be billed as well.

If the payer allows more than 1 encounter on the same day, the second encounter in the office must be reported as an established patient service, since a new patient service applies to the first encounter that day.

There are no appropriate modifiers that can be added to the second E/M service.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q One of our doctors saw a new patient in labor and delivery, and then she was seen in our office for a more extensive exam and ultrasound on the same day, but by a different doctor. Normally I would bill both with a -59 modifier (Distinct procedural service) assigned to an evaluation-and-management (E/M) code, but I was recently told that the -59 modifier should not be assigned to an E/M code. How should I bill for these 2 separate encounters?

A You are correct. While the modifier -59 may be assigned when a distinct and separate service was provided on the same date of service, such as when there is a separate patient encounter, the services referred to in the CPT guidelines are medicine and procedural services, not E/M services. An article in the American Medical Association’s CPT Assistant (January 1999) clarified that the modifier -59 may not be appended to E/M services.

If the patient is seen for the same reason and the physicians are considered the same under the payer’s rules, bill only 1 E/M service for that day, but take into account all of the care the patient received during both encounters to select the right E/M service level. The ultrasound, of course, will be billed as well.

If the payer allows more than 1 encounter on the same day, the second encounter in the office must be reported as an established patient service, since a new patient service applies to the first encounter that day.

There are no appropriate modifiers that can be added to the second E/M service.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q If I saw my patient in the Emergency Department (ED), can I bill one of the 99281–99285 codes for ED visits? Or are these codes only for providers who work for that hospital’s ED?

A No, these codes do not apply exclusively to services provided by the hospital’s ED employees.

You may use ED codes if you are the only one who provided services in that setting. But remember, the codes for ED services require that all 3 key components—history, examination, and medical decision-making—be documented. The “typical times” that are part of most E/M service definitions have not been established for these codes, so selecting the level based on counseling and/or coordination of care is not an option.

Lower relative values

Also keep in mind that the relative values assigned to lower level ED codes 99281 (ED visit; problem-focused history and exam with straightforward medical decision-making) and 99282 (ED visit; expanded problem-focused history and exam with low complexity of medical decision-making) are lower than their equivalent outpatient codes (99201, 99202, 99212, or 99213).

If the ED physician saw the patient first and is billing for that service, you need to bill the outpatient evaluation and management codes (99201–99215) or an outpatient consultation (9941–99245) if you documented a consultation in the record and if the patient is not being seen in the ED for a condition you are actively treating in your office setting.

This assumes you did not admit the patient to either observation status or as an inpatient. In that case, CPT rules would let you bill only the admission, but the code level selected would be based on all services you provided to that patient, on that day.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q If I saw my patient in the Emergency Department (ED), can I bill one of the 99281–99285 codes for ED visits? Or are these codes only for providers who work for that hospital’s ED?

A No, these codes do not apply exclusively to services provided by the hospital’s ED employees.

You may use ED codes if you are the only one who provided services in that setting. But remember, the codes for ED services require that all 3 key components—history, examination, and medical decision-making—be documented. The “typical times” that are part of most E/M service definitions have not been established for these codes, so selecting the level based on counseling and/or coordination of care is not an option.

Lower relative values

Also keep in mind that the relative values assigned to lower level ED codes 99281 (ED visit; problem-focused history and exam with straightforward medical decision-making) and 99282 (ED visit; expanded problem-focused history and exam with low complexity of medical decision-making) are lower than their equivalent outpatient codes (99201, 99202, 99212, or 99213).

If the ED physician saw the patient first and is billing for that service, you need to bill the outpatient evaluation and management codes (99201–99215) or an outpatient consultation (9941–99245) if you documented a consultation in the record and if the patient is not being seen in the ED for a condition you are actively treating in your office setting.

This assumes you did not admit the patient to either observation status or as an inpatient. In that case, CPT rules would let you bill only the admission, but the code level selected would be based on all services you provided to that patient, on that day.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q If I saw my patient in the Emergency Department (ED), can I bill one of the 99281–99285 codes for ED visits? Or are these codes only for providers who work for that hospital’s ED?

A No, these codes do not apply exclusively to services provided by the hospital’s ED employees.

You may use ED codes if you are the only one who provided services in that setting. But remember, the codes for ED services require that all 3 key components—history, examination, and medical decision-making—be documented. The “typical times” that are part of most E/M service definitions have not been established for these codes, so selecting the level based on counseling and/or coordination of care is not an option.

Lower relative values

Also keep in mind that the relative values assigned to lower level ED codes 99281 (ED visit; problem-focused history and exam with straightforward medical decision-making) and 99282 (ED visit; expanded problem-focused history and exam with low complexity of medical decision-making) are lower than their equivalent outpatient codes (99201, 99202, 99212, or 99213).

If the ED physician saw the patient first and is billing for that service, you need to bill the outpatient evaluation and management codes (99201–99215) or an outpatient consultation (9941–99245) if you documented a consultation in the record and if the patient is not being seen in the ED for a condition you are actively treating in your office setting.

This assumes you did not admit the patient to either observation status or as an inpatient. In that case, CPT rules would let you bill only the admission, but the code level selected would be based on all services you provided to that patient, on that day.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q What is the diagnosis code for luteal phase defect?

A Use ICD-9-CM code 256.8 (other ovarian dysfunction) for this condition. The luteal phase refers to the span of time during the menstrual cycle between ovulation and onset of the next menses. Most women have a luteal phase of 10 to 14 days. If the luteal phase lasts less than 10 days or longer than 14 days, the patient may have a luteal phase defect.

You might also consider adding a second code to further clarify the reason for the visit. For instance, evaluation for this problem may be related to infertility or recurrent spontaneous abortions.

If the patient miscarries frequently, let the payer know that the visit was not related to infertility by adding the code V13.29 (personal history of other genital system and obstetric disorders) or 629.9 (habitual aborter without current pregnancy).

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q What is the diagnosis code for luteal phase defect?

A Use ICD-9-CM code 256.8 (other ovarian dysfunction) for this condition. The luteal phase refers to the span of time during the menstrual cycle between ovulation and onset of the next menses. Most women have a luteal phase of 10 to 14 days. If the luteal phase lasts less than 10 days or longer than 14 days, the patient may have a luteal phase defect.

You might also consider adding a second code to further clarify the reason for the visit. For instance, evaluation for this problem may be related to infertility or recurrent spontaneous abortions.

If the patient miscarries frequently, let the payer know that the visit was not related to infertility by adding the code V13.29 (personal history of other genital system and obstetric disorders) or 629.9 (habitual aborter without current pregnancy).

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q What is the diagnosis code for luteal phase defect?

A Use ICD-9-CM code 256.8 (other ovarian dysfunction) for this condition. The luteal phase refers to the span of time during the menstrual cycle between ovulation and onset of the next menses. Most women have a luteal phase of 10 to 14 days. If the luteal phase lasts less than 10 days or longer than 14 days, the patient may have a luteal phase defect.

You might also consider adding a second code to further clarify the reason for the visit. For instance, evaluation for this problem may be related to infertility or recurrent spontaneous abortions.

If the patient miscarries frequently, let the payer know that the visit was not related to infertility by adding the code V13.29 (personal history of other genital system and obstetric disorders) or 629.9 (habitual aborter without current pregnancy).

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q In a recent column, you indicated that the CPT code 57295 (revision [including removal] of prosthetic vaginal graft, vaginal approach) could be used to report revision or removal of an eroded vaginal mesh. What ICD-9 codes would be used for this procedure?

A Normally, erosion is reported as a complication of the procedure, even when it occurs after the global period for the procedure. Since the mesh is considered an internal graft, you will look under the code category 996.6x (infection and inflammatory reaction due to internal prosthetic device, implant, and graft) or 996.7x (other complications of internal [biological] [synthetic] prosthetic device, implant, and graft). The code selection will depend on documentation of the problem with the mesh.

If there was evidence of infection or inflammation, the correct code would be 996.65, specific for a genitourinary device, implant, or graft.

If there was evidence of pain, fibrosis, stenosis, hemorrhage, or erosion, the diagnosis specific to a genitourinary device would be 996.76.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q In a recent column, you indicated that the CPT code 57295 (revision [including removal] of prosthetic vaginal graft, vaginal approach) could be used to report revision or removal of an eroded vaginal mesh. What ICD-9 codes would be used for this procedure?

A Normally, erosion is reported as a complication of the procedure, even when it occurs after the global period for the procedure. Since the mesh is considered an internal graft, you will look under the code category 996.6x (infection and inflammatory reaction due to internal prosthetic device, implant, and graft) or 996.7x (other complications of internal [biological] [synthetic] prosthetic device, implant, and graft). The code selection will depend on documentation of the problem with the mesh.

If there was evidence of infection or inflammation, the correct code would be 996.65, specific for a genitourinary device, implant, or graft.

If there was evidence of pain, fibrosis, stenosis, hemorrhage, or erosion, the diagnosis specific to a genitourinary device would be 996.76.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q In a recent column, you indicated that the CPT code 57295 (revision [including removal] of prosthetic vaginal graft, vaginal approach) could be used to report revision or removal of an eroded vaginal mesh. What ICD-9 codes would be used for this procedure?

A Normally, erosion is reported as a complication of the procedure, even when it occurs after the global period for the procedure. Since the mesh is considered an internal graft, you will look under the code category 996.6x (infection and inflammatory reaction due to internal prosthetic device, implant, and graft) or 996.7x (other complications of internal [biological] [synthetic] prosthetic device, implant, and graft). The code selection will depend on documentation of the problem with the mesh.

If there was evidence of infection or inflammation, the correct code would be 996.65, specific for a genitourinary device, implant, or graft.

If there was evidence of pain, fibrosis, stenosis, hemorrhage, or erosion, the diagnosis specific to a genitourinary device would be 996.76.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q How should I code a failed insertion of a Mirena IUD? The company advised us to use the modifier -53 for the supply and the procedure.

A In this situation, -53 (discontinued procedure) is not correct. The correct modifier for a failed procedure is -52 (reduced services), which should be added to the procedure code for the insertion (58300).

As for the supply, bill the payer for the IUD if an insertion attempt was made, because the attempt renders the supply unusable. In that case, it would be appropriate to add the modifier -52 to the supply code J7302. If the payer denies the claim for the supply, ask the manufacturer for a replacement or refund for the unusable IUD.

Discontinued service (modifier -53) can only be used when the procedure is discontinued due to a problem that threatened the well-being of the patient (such as increased or decreased blood pressure), and you must have carried out surgical prep and anesthesia induction.

Typically, IUD insertion fails because of cervical stenosis, and is coded 622.4 (stricture and stenosis of cervix)—unless another diagnosis explains the failed procedure.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q How should I code a failed insertion of a Mirena IUD? The company advised us to use the modifier -53 for the supply and the procedure.

A In this situation, -53 (discontinued procedure) is not correct. The correct modifier for a failed procedure is -52 (reduced services), which should be added to the procedure code for the insertion (58300).

As for the supply, bill the payer for the IUD if an insertion attempt was made, because the attempt renders the supply unusable. In that case, it would be appropriate to add the modifier -52 to the supply code J7302. If the payer denies the claim for the supply, ask the manufacturer for a replacement or refund for the unusable IUD.

Discontinued service (modifier -53) can only be used when the procedure is discontinued due to a problem that threatened the well-being of the patient (such as increased or decreased blood pressure), and you must have carried out surgical prep and anesthesia induction.

Typically, IUD insertion fails because of cervical stenosis, and is coded 622.4 (stricture and stenosis of cervix)—unless another diagnosis explains the failed procedure.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q How should I code a failed insertion of a Mirena IUD? The company advised us to use the modifier -53 for the supply and the procedure.

A In this situation, -53 (discontinued procedure) is not correct. The correct modifier for a failed procedure is -52 (reduced services), which should be added to the procedure code for the insertion (58300).

As for the supply, bill the payer for the IUD if an insertion attempt was made, because the attempt renders the supply unusable. In that case, it would be appropriate to add the modifier -52 to the supply code J7302. If the payer denies the claim for the supply, ask the manufacturer for a replacement or refund for the unusable IUD.

Discontinued service (modifier -53) can only be used when the procedure is discontinued due to a problem that threatened the well-being of the patient (such as increased or decreased blood pressure), and you must have carried out surgical prep and anesthesia induction.

Typically, IUD insertion fails because of cervical stenosis, and is coded 622.4 (stricture and stenosis of cervix)—unless another diagnosis explains the failed procedure.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q How should I bill for a laparoscopic supracervical hysterectomy?

A If the ovaries are not removed, your code choices are 58550 (laparoscopy surgical with vaginal hysterectomy for uterus 250 grams or less) or 58553 (laparoscopy surgical with vaginal hysterectomy for uterus greater than 250 grams).

But you need to add a modifier -52 (reduced services) because the surgeon elected not to remove the cervix.

Keep in mind that a new “S” code (S2078, laparoscopic supracervical hysterectomy [subtotal hysterectomy] with or without removal of tube[s], with or without removal of ovary[s]) is added to the national code set by Blue Cross/Blue Shield.

If you are billing a carrier that uses the “S” codes for processing claims, you must use the S code instead of code 58550/58553-52.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q How should I bill for a laparoscopic supracervical hysterectomy?

A If the ovaries are not removed, your code choices are 58550 (laparoscopy surgical with vaginal hysterectomy for uterus 250 grams or less) or 58553 (laparoscopy surgical with vaginal hysterectomy for uterus greater than 250 grams).

But you need to add a modifier -52 (reduced services) because the surgeon elected not to remove the cervix.

Keep in mind that a new “S” code (S2078, laparoscopic supracervical hysterectomy [subtotal hysterectomy] with or without removal of tube[s], with or without removal of ovary[s]) is added to the national code set by Blue Cross/Blue Shield.

If you are billing a carrier that uses the “S” codes for processing claims, you must use the S code instead of code 58550/58553-52.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q How should I bill for a laparoscopic supracervical hysterectomy?

A If the ovaries are not removed, your code choices are 58550 (laparoscopy surgical with vaginal hysterectomy for uterus 250 grams or less) or 58553 (laparoscopy surgical with vaginal hysterectomy for uterus greater than 250 grams).

But you need to add a modifier -52 (reduced services) because the surgeon elected not to remove the cervix.

Keep in mind that a new “S” code (S2078, laparoscopic supracervical hysterectomy [subtotal hysterectomy] with or without removal of tube[s], with or without removal of ovary[s]) is added to the national code set by Blue Cross/Blue Shield.

If you are billing a carrier that uses the “S” codes for processing claims, you must use the S code instead of code 58550/58553-52.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Does the revised code 82270 for fecal occult blood replace the Medicare code G0107 (colorectal cancer screening; fecal-occult blood test, 1–3 simultaneous determinations)?

A No. Medicare will continue to require that a screening guaiac fecal occult blood test be billed using G0107.

The revised CPT code 82270, however, affects the way you can bill for the guaiac fecal occult blood test.

The CPT 2006 revised code now states that the patient is provided with 3 cards or a single triple card for consecutive collection. The changed nomenclature states that this code is to be used for screening.

Effective January 1, 2006, the code 82270 does not apply when the physician takes the sample in the office.

The new code, 82272 (blood, occult, by peroxidase activity [guaiac], qualitative, feces, single specimen [from digital rectal exam]) should be used for this circumstance.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Does the revised code 82270 for fecal occult blood replace the Medicare code G0107 (colorectal cancer screening; fecal-occult blood test, 1–3 simultaneous determinations)?

A No. Medicare will continue to require that a screening guaiac fecal occult blood test be billed using G0107.

The revised CPT code 82270, however, affects the way you can bill for the guaiac fecal occult blood test.

The CPT 2006 revised code now states that the patient is provided with 3 cards or a single triple card for consecutive collection. The changed nomenclature states that this code is to be used for screening.

Effective January 1, 2006, the code 82270 does not apply when the physician takes the sample in the office.

The new code, 82272 (blood, occult, by peroxidase activity [guaiac], qualitative, feces, single specimen [from digital rectal exam]) should be used for this circumstance.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Does the revised code 82270 for fecal occult blood replace the Medicare code G0107 (colorectal cancer screening; fecal-occult blood test, 1–3 simultaneous determinations)?

A No. Medicare will continue to require that a screening guaiac fecal occult blood test be billed using G0107.

The revised CPT code 82270, however, affects the way you can bill for the guaiac fecal occult blood test.

The CPT 2006 revised code now states that the patient is provided with 3 cards or a single triple card for consecutive collection. The changed nomenclature states that this code is to be used for screening.

Effective January 1, 2006, the code 82270 does not apply when the physician takes the sample in the office.

The new code, 82272 (blood, occult, by peroxidase activity [guaiac], qualitative, feces, single specimen [from digital rectal exam]) should be used for this circumstance.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q How should I bill a 3D ultrasound of the fetus?

A Keep in mind that most payers still consider 3-dimensional fetal ultrasound an expensive “new science” that is not being reimbursed. Be sure that you have a sound medical indication for 3D ultrasound, and be sure that the patient is made aware that this procedure may not be covered by her insurance company.

Two new codes represent 3D rendering of an ultrasound.

• Code 76376 is reported in addition to the basic service (detailed obstetric ultrasound 76811) when the image does not require image postprocessing on an independent workstation.
  
• Code 76377 is reported if image postprocessing is performed on an independent workstation.
  

According to CPT guidelines, these 2 codes also require “concurrent physician supervision of the image postprocessing 3D manipulation.” Previously, the only code available for 3D manipulation was 76375, a code that did not mention conversion from an ultrasound. Code 76375 has been deleted from CPT 2006.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q How should I bill a 3D ultrasound of the fetus?

A Keep in mind that most payers still consider 3-dimensional fetal ultrasound an expensive “new science” that is not being reimbursed. Be sure that you have a sound medical indication for 3D ultrasound, and be sure that the patient is made aware that this procedure may not be covered by her insurance company.

Two new codes represent 3D rendering of an ultrasound.

• Code 76376 is reported in addition to the basic service (detailed obstetric ultrasound 76811) when the image does not require image postprocessing on an independent workstation.
  
• Code 76377 is reported if image postprocessing is performed on an independent workstation.
  

According to CPT guidelines, these 2 codes also require “concurrent physician supervision of the image postprocessing 3D manipulation.” Previously, the only code available for 3D manipulation was 76375, a code that did not mention conversion from an ultrasound. Code 76375 has been deleted from CPT 2006.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q How should I bill a 3D ultrasound of the fetus?

A Keep in mind that most payers still consider 3-dimensional fetal ultrasound an expensive “new science” that is not being reimbursed. Be sure that you have a sound medical indication for 3D ultrasound, and be sure that the patient is made aware that this procedure may not be covered by her insurance company.

Two new codes represent 3D rendering of an ultrasound.

• Code 76376 is reported in addition to the basic service (detailed obstetric ultrasound 76811) when the image does not require image postprocessing on an independent workstation.
  
• Code 76377 is reported if image postprocessing is performed on an independent workstation.
  

According to CPT guidelines, these 2 codes also require “concurrent physician supervision of the image postprocessing 3D manipulation.” Previously, the only code available for 3D manipulation was 76375, a code that did not mention conversion from an ultrasound. Code 76375 has been deleted from CPT 2006.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.