Reimbursement Advisor

Q Which CPT codes are recommended for low-risk and high-risk Medicare pelvic/breast exams for women aged 65 and older? Are the rules the same for non-Medicare third-party payers?

A For any screening pelvic/breast exam, Medicare requires that the alphanumeric Healthcare Common Procedure Coding System code (rather than a CPT preventive medicine code) you submit be linked to a specific ICD-9 code.

For the screening, you would report G0101 (cervical or vaginal cancer screening, pelvic and clinical breast examination), regardless of whether the patient is at low or high risk for cervical or vaginal cancer. Medicare only differentiates between the risk categories via the ICD-9 diagnostic code you use.

If the patient is at low risk, use ICD-9 code V76.2 (special screening for malignant neoplasms, cervix) or V76.49 (special screening for malignant neoplasms, other sites). Effective October 1, 2003, the code V76.47 (special screening for malignant neoplasms, vagina) may also be used. Note that V76.49 (and V76.47) is used only when the patient has had her uterus removed for reasons other than malignancy. If the patient is at high risk, the diagnosis changes to V15.89 (other specified personal history presenting hazards to health), along with a second code indicating which of Medicare’s 5 high-risk criteria applies. For a woman past childbearing age (which is all patients 65 or older), these criteria are:

• early onset of sexual activity (under 16 years of age) or multiple sexual partners (5 or more in a lifetime)—use V69.2, high-risk sexual behavior;
  
• history of a sexually transmitted disease (including HIV infection)—use V13.8, personal history of other diseases; V08, asymptomatic HIV; or 042, HIV infection;
  
• fewer than 3 negative Pap smears within the previous 7 years—use the diagnosis known at the time of the last Pap smear (if normal, use the code V13.2 for personal history of genitourinary disorder to indicate a previous abnormal Pap result); and
  
• diethylstilbestrol-exposed daughters of women who took the drug during pregnancy—use 760.76 (DES exposure).
  

Non-Medicare insurers have different rules: Unlike Medicare, they tend to pay for a comprehensive well-woman exam each year, billed using 1 of the CPT preventive medicine codes (99381 to 99397). The diagnostic coding is also different—specifically V72.3, gynecologic exam with Pap smear.

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-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Which CPT codes are recommended for low-risk and high-risk Medicare pelvic/breast exams for women aged 65 and older? Are the rules the same for non-Medicare third-party payers?

A For any screening pelvic/breast exam, Medicare requires that the alphanumeric Healthcare Common Procedure Coding System code (rather than a CPT preventive medicine code) you submit be linked to a specific ICD-9 code.

For the screening, you would report G0101 (cervical or vaginal cancer screening, pelvic and clinical breast examination), regardless of whether the patient is at low or high risk for cervical or vaginal cancer. Medicare only differentiates between the risk categories via the ICD-9 diagnostic code you use.

If the patient is at low risk, use ICD-9 code V76.2 (special screening for malignant neoplasms, cervix) or V76.49 (special screening for malignant neoplasms, other sites). Effective October 1, 2003, the code V76.47 (special screening for malignant neoplasms, vagina) may also be used. Note that V76.49 (and V76.47) is used only when the patient has had her uterus removed for reasons other than malignancy. If the patient is at high risk, the diagnosis changes to V15.89 (other specified personal history presenting hazards to health), along with a second code indicating which of Medicare’s 5 high-risk criteria applies. For a woman past childbearing age (which is all patients 65 or older), these criteria are:

• early onset of sexual activity (under 16 years of age) or multiple sexual partners (5 or more in a lifetime)—use V69.2, high-risk sexual behavior;
  
• history of a sexually transmitted disease (including HIV infection)—use V13.8, personal history of other diseases; V08, asymptomatic HIV; or 042, HIV infection;
  
• fewer than 3 negative Pap smears within the previous 7 years—use the diagnosis known at the time of the last Pap smear (if normal, use the code V13.2 for personal history of genitourinary disorder to indicate a previous abnormal Pap result); and
  
• diethylstilbestrol-exposed daughters of women who took the drug during pregnancy—use 760.76 (DES exposure).
  

Non-Medicare insurers have different rules: Unlike Medicare, they tend to pay for a comprehensive well-woman exam each year, billed using 1 of the CPT preventive medicine codes (99381 to 99397). The diagnostic coding is also different—specifically V72.3, gynecologic exam with Pap smear.

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-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Which CPT codes are recommended for low-risk and high-risk Medicare pelvic/breast exams for women aged 65 and older? Are the rules the same for non-Medicare third-party payers?

A For any screening pelvic/breast exam, Medicare requires that the alphanumeric Healthcare Common Procedure Coding System code (rather than a CPT preventive medicine code) you submit be linked to a specific ICD-9 code.

For the screening, you would report G0101 (cervical or vaginal cancer screening, pelvic and clinical breast examination), regardless of whether the patient is at low or high risk for cervical or vaginal cancer. Medicare only differentiates between the risk categories via the ICD-9 diagnostic code you use.

If the patient is at low risk, use ICD-9 code V76.2 (special screening for malignant neoplasms, cervix) or V76.49 (special screening for malignant neoplasms, other sites). Effective October 1, 2003, the code V76.47 (special screening for malignant neoplasms, vagina) may also be used. Note that V76.49 (and V76.47) is used only when the patient has had her uterus removed for reasons other than malignancy. If the patient is at high risk, the diagnosis changes to V15.89 (other specified personal history presenting hazards to health), along with a second code indicating which of Medicare’s 5 high-risk criteria applies. For a woman past childbearing age (which is all patients 65 or older), these criteria are:

• early onset of sexual activity (under 16 years of age) or multiple sexual partners (5 or more in a lifetime)—use V69.2, high-risk sexual behavior;
  
• history of a sexually transmitted disease (including HIV infection)—use V13.8, personal history of other diseases; V08, asymptomatic HIV; or 042, HIV infection;
  
• fewer than 3 negative Pap smears within the previous 7 years—use the diagnosis known at the time of the last Pap smear (if normal, use the code V13.2 for personal history of genitourinary disorder to indicate a previous abnormal Pap result); and
  
• diethylstilbestrol-exposed daughters of women who took the drug during pregnancy—use 760.76 (DES exposure).
  

Non-Medicare insurers have different rules: Unlike Medicare, they tend to pay for a comprehensive well-woman exam each year, billed using 1 of the CPT preventive medicine codes (99381 to 99397). The diagnostic coding is also different—specifically V72.3, gynecologic exam with Pap smear.

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-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q For laparoscopy with lysis of adhesions, peritoneal washings, peritoneal biopsies, and left ovarian excrescence removal for biopsy, should I use code 58662?

A Code 58662 (laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method) would cover the removal of the left ovarian excrescences, but does not capture the lysis of adhesions. Many payers bundle this procedure because they believe it is incidental. However, if the adhesions were extensive and the extra time the physician spent in removing them is well documented, you can either bill the lysis separately using code 58660-59-51 (to indicate it was a distinct, multiple procedure) or you can add modifier -22 (unusual procedure) to code 58662 to indicate extensive additional work. Note that you would only use this latter option for payers you know always bundle lysis of adhesions when billed separately (Medicare, for example).

The payer is unlikely to reimburse separately for peritoneal washings and biopsy.

Q For laparoscopy with lysis of adhesions, peritoneal washings, peritoneal biopsies, and left ovarian excrescence removal for biopsy, should I use code 58662?

A Code 58662 (laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method) would cover the removal of the left ovarian excrescences, but does not capture the lysis of adhesions. Many payers bundle this procedure because they believe it is incidental. However, if the adhesions were extensive and the extra time the physician spent in removing them is well documented, you can either bill the lysis separately using code 58660-59-51 (to indicate it was a distinct, multiple procedure) or you can add modifier -22 (unusual procedure) to code 58662 to indicate extensive additional work. Note that you would only use this latter option for payers you know always bundle lysis of adhesions when billed separately (Medicare, for example).

The payer is unlikely to reimburse separately for peritoneal washings and biopsy.

Q For laparoscopy with lysis of adhesions, peritoneal washings, peritoneal biopsies, and left ovarian excrescence removal for biopsy, should I use code 58662?

A Code 58662 (laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method) would cover the removal of the left ovarian excrescences, but does not capture the lysis of adhesions. Many payers bundle this procedure because they believe it is incidental. However, if the adhesions were extensive and the extra time the physician spent in removing them is well documented, you can either bill the lysis separately using code 58660-59-51 (to indicate it was a distinct, multiple procedure) or you can add modifier -22 (unusual procedure) to code 58662 to indicate extensive additional work. Note that you would only use this latter option for payers you know always bundle lysis of adhesions when billed separately (Medicare, for example).

The payer is unlikely to reimburse separately for peritoneal washings and biopsy.

Q: How would you code a sacrospinous ligament vaginal suspension, repair of enterocele, and cystocele? This is a Medicare patient with a preoperative diagnosis of total vaginal prolapse, status post-vaginal hysterectomy with anterior and posterior repair, third-degree enterocele, and second-degree rectocele recurrent.

A: When coding any surgery for Medicare submission, it’s always a good idea to check the Correct Coding Initiative (CCI) to see which code combinations are bundled. In this case, the codes you can choose from include 57282 (for sacrospinous ligament fixation), 57240 (for cystocele repair), and 57268 (for vaginal-approach enterocele repair).

Unfortunately, CCI indicates code 57268 is not payable with code 57282. To make matters worse, you can’t bypass the edit, since this code combination is never paid. According to CCI, this is because the vaginal-approach enterocele repair is a CPT “separate procedure” and Medicare has decided that it and the sacrospinous ligament fixation are always integral to each other.

If this had been a case where a posterior repair had been done along with the anterior colporrhaphy and enterocele repair, you could have assigned code 57265 (combined antero-posterior colporrhaphy; with enterocele repair) as your second procedure, since it isn’t bundled with the sacrospinous ligament fixation procedure. You may be tempted, then, to bill code 57265 with a modifier -52 (reduced services) to get the claim paid, but I would advise against it, as this coding isn’t the most accurate description of what was done.

Instead, because there was a symptomatic enterocele that needed to be repaired, I would add a modifier -22 (unusual procedure) to code 57282 and send in supporting documentation regarding the need for the enterocele repair. Centers for Medicare & Medicaid Services staff recommended this solution a few years ago for any procedure that’s always bundled into a larger procedure, when the documentation supports performing it.

Q: How would you code a sacrospinous ligament vaginal suspension, repair of enterocele, and cystocele? This is a Medicare patient with a preoperative diagnosis of total vaginal prolapse, status post-vaginal hysterectomy with anterior and posterior repair, third-degree enterocele, and second-degree rectocele recurrent.

A: When coding any surgery for Medicare submission, it’s always a good idea to check the Correct Coding Initiative (CCI) to see which code combinations are bundled. In this case, the codes you can choose from include 57282 (for sacrospinous ligament fixation), 57240 (for cystocele repair), and 57268 (for vaginal-approach enterocele repair).

Unfortunately, CCI indicates code 57268 is not payable with code 57282. To make matters worse, you can’t bypass the edit, since this code combination is never paid. According to CCI, this is because the vaginal-approach enterocele repair is a CPT “separate procedure” and Medicare has decided that it and the sacrospinous ligament fixation are always integral to each other.

If this had been a case where a posterior repair had been done along with the anterior colporrhaphy and enterocele repair, you could have assigned code 57265 (combined antero-posterior colporrhaphy; with enterocele repair) as your second procedure, since it isn’t bundled with the sacrospinous ligament fixation procedure. You may be tempted, then, to bill code 57265 with a modifier -52 (reduced services) to get the claim paid, but I would advise against it, as this coding isn’t the most accurate description of what was done.

Instead, because there was a symptomatic enterocele that needed to be repaired, I would add a modifier -22 (unusual procedure) to code 57282 and send in supporting documentation regarding the need for the enterocele repair. Centers for Medicare & Medicaid Services staff recommended this solution a few years ago for any procedure that’s always bundled into a larger procedure, when the documentation supports performing it.

Q: How would you code a sacrospinous ligament vaginal suspension, repair of enterocele, and cystocele? This is a Medicare patient with a preoperative diagnosis of total vaginal prolapse, status post-vaginal hysterectomy with anterior and posterior repair, third-degree enterocele, and second-degree rectocele recurrent.

A: When coding any surgery for Medicare submission, it’s always a good idea to check the Correct Coding Initiative (CCI) to see which code combinations are bundled. In this case, the codes you can choose from include 57282 (for sacrospinous ligament fixation), 57240 (for cystocele repair), and 57268 (for vaginal-approach enterocele repair).

Unfortunately, CCI indicates code 57268 is not payable with code 57282. To make matters worse, you can’t bypass the edit, since this code combination is never paid. According to CCI, this is because the vaginal-approach enterocele repair is a CPT “separate procedure” and Medicare has decided that it and the sacrospinous ligament fixation are always integral to each other.

If this had been a case where a posterior repair had been done along with the anterior colporrhaphy and enterocele repair, you could have assigned code 57265 (combined antero-posterior colporrhaphy; with enterocele repair) as your second procedure, since it isn’t bundled with the sacrospinous ligament fixation procedure. You may be tempted, then, to bill code 57265 with a modifier -52 (reduced services) to get the claim paid, but I would advise against it, as this coding isn’t the most accurate description of what was done.

Instead, because there was a symptomatic enterocele that needed to be repaired, I would add a modifier -22 (unusual procedure) to code 57282 and send in supporting documentation regarding the need for the enterocele repair. Centers for Medicare & Medicaid Services staff recommended this solution a few years ago for any procedure that’s always bundled into a larger procedure, when the documentation supports performing it.

Q One of our providers (a midwife) had 13 antepartum visits with a patient, only to have the patient require a cesarean. I know 59426 covers 7 or more visits, but with 13, should we submit the related notes with a paper claim?

A The code 59426 is used for any number of antepartum visits equaling 7 or more, so the midwife’s care will indeed fall under this code definition. However, you might be interested to know that the code was valued under the Medicare resource-based relative value scale system on the assumption that the average number of visits would be 10 (1 initial and 9 subsequent antepartum visits). If the midwife documented significant additional work due to developing complications at the end of the pregnancy, adding modifier-22 (unusual services) may be appropriate.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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 providers (a midwife) had 13 antepartum visits with a patient, only to have the patient require a cesarean. I know 59426 covers 7 or more visits, but with 13, should we submit the related notes with a paper claim?

A The code 59426 is used for any number of antepartum visits equaling 7 or more, so the midwife’s care will indeed fall under this code definition. However, you might be interested to know that the code was valued under the Medicare resource-based relative value scale system on the assumption that the average number of visits would be 10 (1 initial and 9 subsequent antepartum visits). If the midwife documented significant additional work due to developing complications at the end of the pregnancy, adding modifier-22 (unusual services) may be appropriate.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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 providers (a midwife) had 13 antepartum visits with a patient, only to have the patient require a cesarean. I know 59426 covers 7 or more visits, but with 13, should we submit the related notes with a paper claim?

A The code 59426 is used for any number of antepartum visits equaling 7 or more, so the midwife’s care will indeed fall under this code definition. However, you might be interested to know that the code was valued under the Medicare resource-based relative value scale system on the assumption that the average number of visits would be 10 (1 initial and 9 subsequent antepartum visits). If the midwife documented significant additional work due to developing complications at the end of the pregnancy, adding modifier-22 (unusual services) may be appropriate.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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 CPT code for the new PapSure exam (Watson Diagnostics, Inc, Corona, Calif)?

A PapSure, according to the company’s brochure, is a new visual cervical screening exam that is performed right after the Pap smear sample is collected. The physician first washes the cervix with a mild solution, then examines it visually using a small disposable blue light and a special magnifying lens. The blue light causes abnormal tissue to appear bright white, helping clinicians better detect possibly harmful abnormalities.

To my knowledge, no payers are covering this exam yet. A few of the practices I talked to are collecting directly from the patient, using the unlisted code 58999. This is because, until recently, there was no CPT code for the procedure. But in July 2002, CPT added two Category III codes to cover billing for this procedure: 0031T (speculoscopy) and 0032T (speculoscopy; with directed sampling).

Category III codes, to be used in place of the unlisted codes, are assigned to new technologies that either are not currently a standard of care or need more data to prove their efficacy. It is unlikely that payers will reimburse for this test at present, but 1 or 2 might consider it if you can negotiate the service.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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 CPT code for the new PapSure exam (Watson Diagnostics, Inc, Corona, Calif)?

A PapSure, according to the company’s brochure, is a new visual cervical screening exam that is performed right after the Pap smear sample is collected. The physician first washes the cervix with a mild solution, then examines it visually using a small disposable blue light and a special magnifying lens. The blue light causes abnormal tissue to appear bright white, helping clinicians better detect possibly harmful abnormalities.

To my knowledge, no payers are covering this exam yet. A few of the practices I talked to are collecting directly from the patient, using the unlisted code 58999. This is because, until recently, there was no CPT code for the procedure. But in July 2002, CPT added two Category III codes to cover billing for this procedure: 0031T (speculoscopy) and 0032T (speculoscopy; with directed sampling).

Category III codes, to be used in place of the unlisted codes, are assigned to new technologies that either are not currently a standard of care or need more data to prove their efficacy. It is unlikely that payers will reimburse for this test at present, but 1 or 2 might consider it if you can negotiate the service.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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 CPT code for the new PapSure exam (Watson Diagnostics, Inc, Corona, Calif)?

A PapSure, according to the company’s brochure, is a new visual cervical screening exam that is performed right after the Pap smear sample is collected. The physician first washes the cervix with a mild solution, then examines it visually using a small disposable blue light and a special magnifying lens. The blue light causes abnormal tissue to appear bright white, helping clinicians better detect possibly harmful abnormalities.

To my knowledge, no payers are covering this exam yet. A few of the practices I talked to are collecting directly from the patient, using the unlisted code 58999. This is because, until recently, there was no CPT code for the procedure. But in July 2002, CPT added two Category III codes to cover billing for this procedure: 0031T (speculoscopy) and 0032T (speculoscopy; with directed sampling).

Category III codes, to be used in place of the unlisted codes, are assigned to new technologies that either are not currently a standard of care or need more data to prove their efficacy. It is unlikely that payers will reimburse for this test at present, but 1 or 2 might consider it if you can negotiate the service.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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 a patient is on metformin for insulin resistance, what is the diagnostic code for insulin resistance if the patient is not pregnant? She will be undergoing in vitro fertilization.

A Metformin is generally used as an oral agent to help control type 2 diabetes, but your question suggests another use for the drug. Recent evidence indicates that metformin may facilitate ovulation in some women with polycystic ovary syndrome (PCOS) when taken in combination with clomiphene. Since the PCOS usually causes the insulin resistance that may, in turn, cause the infertility, I would suggest PCOS (ICD-9-CM 256.4) as the most accurate diagnosis. Still, infertility remains the primary diagnosis, which means you’ll need to list code 628.0 (female infertility associated with anovulation) first on the claim.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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 a patient is on metformin for insulin resistance, what is the diagnostic code for insulin resistance if the patient is not pregnant? She will be undergoing in vitro fertilization.

A Metformin is generally used as an oral agent to help control type 2 diabetes, but your question suggests another use for the drug. Recent evidence indicates that metformin may facilitate ovulation in some women with polycystic ovary syndrome (PCOS) when taken in combination with clomiphene. Since the PCOS usually causes the insulin resistance that may, in turn, cause the infertility, I would suggest PCOS (ICD-9-CM 256.4) as the most accurate diagnosis. Still, infertility remains the primary diagnosis, which means you’ll need to list code 628.0 (female infertility associated with anovulation) first on the claim.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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 a patient is on metformin for insulin resistance, what is the diagnostic code for insulin resistance if the patient is not pregnant? She will be undergoing in vitro fertilization.

A Metformin is generally used as an oral agent to help control type 2 diabetes, but your question suggests another use for the drug. Recent evidence indicates that metformin may facilitate ovulation in some women with polycystic ovary syndrome (PCOS) when taken in combination with clomiphene. Since the PCOS usually causes the insulin resistance that may, in turn, cause the infertility, I would suggest PCOS (ICD-9-CM 256.4) as the most accurate diagnosis. Still, infertility remains the primary diagnosis, which means you’ll need to list code 628.0 (female infertility associated with anovulation) first on the claim.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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.

There’s good news and bad news for OBG coders in 2003. The bad news is that the wealth of new Current Procedural Terminology (CPT) codes means practices must make some serious changes to their office procedures encounter form. The good news is that these long-awaited changes should make it easier for physicians to communicate to insurers the type and difficulty of many routine procedures.

In addition to the OBG-relevant changes highlighted in this article, a wide range of other code and editorial updates have been made. For instance, CPT has deleted the optional 5-digit modifier codes that could have been used instead of the 2 digit modifier. (For example, CPT defined that the modifier to signify a separate and significant E/M service could be reported as either modifier -25 or by using the code 09925. With CPT 2003, only the modifier would be reported.) This change was necessary because the uniform electronic claim set up as a result of Health Insurance Portability and Accountability Act regulations can only accommodate 2-character modifiers. Coders should therefore review CPT 2003 in full to ensure that all relevant changes are captured.

A note about formatting: Codes marked in red are new in CPT 2003, while blue codes have been revised since the last edition. When a code has 1 or more indented codes following it, the indented text replaces everything following the semicolon in the initial code.

Updated pap smear codes

Pap smear codes have been revised to more clearly represent current screening techniques. Codes 88144 and 88145—which described the ThinPrep (Cytyc Corporation, Boxborough, Mass) manual screening and computer-assisted rescreening—have been deleted, but 2 new codes have been added:

• 88174 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision
  
• 88175 with screening by automated system and manual rescreening, under physician supervision
  

For manual screening, coders should refer to codes 88142 and 88143.

Counting leukocytes, testing semen

• 89055 leukocyte count, fecal
  

This new code, added to describe laboratory testing for fecal leukocytes, replaces the Health Care Financing Administrators Common Procedure Coding System (HCPCS) Level II G code G0026 (fecal leukocyte examination).

• 89300 Semen analysis; presence and/or motility of sperm including Huhner test (post coital);
  
• 89310 Motility and count, not including Huhner test.
  

While 89300 has not changed, 89310 was revised to specifically exclude Huhner testing. It will replace the HCPCS Level II G code G0027 (semen analysis presence and/or motility of sperm excluding Huhner test).

The biggest change: diagnostic ultrasound codes

Possibly the most significant change in CPT coding comes in the area of obstetric ultrasound. These codes have been revamped to allow maternal-fetal specialists to report accurately the ultrasound procedures they perform. A new guideline note that precedes this section gives a clear definition of what the codes in that section include. For instance, the guidelines state regarding 2 of the codes:

“Codes 76801 and 76802 include determination of the number of gestational sacs and fetuses, gestational sac/fetal measurements appropriate for gestation (

Coders should spend time reviewing this section to ensure correct billing. Please also note that the codes 76802, 76810 and 76812 are designated by CPT as “add-on” codes. This means that they do not require a modifier to indicate a multiple procedure (i.e., modifier-51):

• 76801 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (
• 76802 each additional gestation (List separately in addition to code for primary procedure performed.)
  

(Use 76802 in conjunction with 76801.)

• 76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (14 weeks 0 days), transabdominal approach; single or first gestation
  
• 76810 each additional gestation (List separately in addition to code for primary procedure performed.)
  

(Use 76810 in conjunction with 76805.)

• 76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation
  
• 76812 each additional gestation (List separately in addition to code for primary procedure performed.)
  

(Use 76812 in conjunction with 76811.)

 

• 76815 Ultrasound, pregnant uterus, real time with image documentation, limited (e.g., fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses
  

(Use 76815 only once per exam, not per element.)

• 76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up (e.g., reevaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, reevaluation of organ system[s] suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetus
  

(Report 76816 with modifier -59 [distinct procedure] for each additional fetus examined in a multiple pregnancy.)

• 76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal
  

(If transvaginal examination is done in addition to transabdominal obstetrical ultrasound exam, use 76817 as well as the appropriate transabdominal exam code. For nonobstetrical transvaginal ultrasound, use code 76830 [ultrasound, transvaginal].)

Multiple births. There has also been a change in CPT instructions for coding multiple fetuses when performing a fetal biophysical profile (BPP). In the past, CPT instructed coders to use modifier -51 (multiple procedures) with each BPP code reported at that session after the first fetus (e.g., 76818, 76818-51 for twins). Now CPT indicates that a BPP done on additional fetuses should be reported separately by adding the modifier -59 (distinct procedure) to code 76818 (fetal biophysical profile; with non-stress testing) or 76819 (fetal biophysical profile without non-stress testing).

Transvaginal examination. CPT now explicitly states that if a transvaginal examination is done in addition to a transabdominal gynecologic ultrasound exam, coders should use code 76830 in addition to the appropriate transabdominal exam code (76856-76857).

Bone density studies

CPT now differentiates between a study done on the axial skeleton and one done on the peripheral skeleton, thanks to the revision of 1 code and the addition of a second:

• 76070 Computed tomography, bone mineral density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine)
  
• 76071 appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
  

Vaginal hysterectomy

The codes listed below were revised or added to account for the additional work involved in removing a large uterus vaginally. Report these new codes when the operative report includes a description of how the uterus was removed—by bisection, morcellation, or myomectomy and coring—and confirms the weight of the uterus. As with an abdominal hysterectomy, fibroid removal prior to uterus removal is considered an integral part of the procedure, and therefore is not reported separately. Note that if the weight of the uterus is not known at the time the procedure is coded, the default would be to code for the uterus that weighs 250 g or less.

• 58550 Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 grams or less;
  
• 58552 with removal of tube(s) and/or ovary(s)
  
• 58553 Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 grams;
  
• 58554 with removal of tube(s) and/or ovary(s)
  
• 58260 Vaginal hysterectomy for uterus 250 grams or less;
  
• 58262 with removal of tube(s) and ovary(s)
  
• 58263 with removal of tube(s), and/or ovary(s), with repair of enterocele
  
• 58267 with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control
  
• 58270 with repair of enterocele
  
• 58290 Vaginal hysterectomy, for uterus greater than 250 grams;
  
• 58291 with removal of tube(s) and/or ovary(s)
  
• 58292 with removal of tube(s) and/or ovary(s), with repair of enterocele
  
• 58293 with colpo-urethrocysto-pexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control
  
• 58294 with repair of enterocele
  

Myomectomy

CPT changed the uterine-fibroid removal codes to account for the more involved surgical work required for larger or multiple fibroids:

• 58140 Myomectomy, excision of fibroid tumor(s) of uterus, 1 to 4 intramural myoma(s) with total weight of 250 grams or less and/or removal of surface myoma(s); abdominal approach
  
• 58145 vaginal approach
  
• 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
  

(Do not report 58146 in addition to 58140-58145 or 58150-58240 [abdominal hysterectomy codes].)

• 58545 Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight of 250 grams or less and/or removal of surface myomas
  
• 58546 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 grams
  

Coders should note that code 58551 (laparoscopy, surgical; with removal of leiomyomata [single or multiple]) has been deleted. In its place coders would report either 58545 or 58546. CPT has also clarified that the “abdominal approach” myomectomy codes should not be reported in addition to the abdominal hysterectomy codes (58150-58240).

Colposcopy procedures

CPT 2003 contains new and revised codes for colposcopy of the vulva, cervix, and vagina:

• 56820 Colposcopy of the vulva;
  
• 56821 with biopsy(s)
  
• 57420 Colposcopy of the entire vagina, with cervix if present;
  
• 57421 with biopsy(s)
  

 

(For cervicography, see Category III code 0003T.)

• 57452 Colposcopy of the cervix including upper/adjacent vagina;
  
• 57454 with biopsy(s) of the cervix and endocervical curettage
  
• 57455 with biopsy(s) of the cervix
  
• 57456 with endocervical curettage
  
• 57460 with loop electrode biopsy(s) of the cervix
  
• 57461 with loop electrode conization of the cervix
  

Coders should note the following guidelines:

• If colposcopy is performed on both the vagina and vulva, both procedures may be reported, with modifier -51 added to the code of lesser relative value.
  
• A superficial cervical examination is considered part of a complete vaginal examination (codes 57420 and 57421), if performed.
  
• If the main purpose of the examination is to evaluate the cervix, not the vagina, only the cervical colposcopy codes (54452-57461) would be reported.
  
• Colposcopy of the cervix codes (54452-57461) include an examination of the entire cervix as well as the upper/adjacent portion of the vagina.
  
• Code 57460 has been revised and code 57461 added to clarify the 2 different cervical loop electrode excision procedures that might be done in conjunction with colposcopy. Code 57460 includes removal of the exocervix and a portion of the transformation zone, if necessary. Code 57461 represents a conization procedure that takes all of the exocervix, the transformation zone, and some or all of the endocervix.
  
• An endocervical curettage is included as part of a conization; therefore code 57456 would not be reported in addition to code 57461.
  

Bladder procedures, incontinence testing

Three new codes were developed to replace HCPCS code G0002 (office procedure, insertion of temporary indwelling catheter, Foley type [separate procedure]). These would be reported only when the catheter insertion is an independent procedure, not part of another procedure.

Codes 53670 and 53675 (both catheterization procedures listed under the heading “urethra”) have been deleted. In their place are new codes that are more appropriate.

• 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)
  

Urodynamics. Code 51798 (measurement of postvoiding residual urine and/or bladder capacity by ultrasound, nonimaging) replaces code 78730, which had been inaccurately placed in CPT’s nuclear medicine section, as well as the HCPCS Level II G code G0050 (measurement of postvoiding residual urine and/or bladder capacity by ultrasound, nonimaging). The new code represents a more accurate description of this noninvasive procedure, which uses a handheld Doppler ultrasonic device. This code represents only the technical component of the procedure, and is not associated with physician work that involves interpretation because the device gives a numeric result.

Abdominal procedures

• 49419 Insertion of intraperitoneal cannula or catheter, with subcutaneous reservoir, permanent (i.e., totally implantable)
  

This would be reported by gynecologic oncologists who want to provide intraperitoneal chemotherapy in women with ovarian or primary peritoneal cancer. The procedure requires an incision and the creation of a pocket for the reservoir.

For the removal of these devices, use code 49422.

Blood collection

• 36415 Collection of venous blood by venipuncture
  
• 36416 Collection of capillary blood specimen (e.g., finger, heel, ear stick)
  

Code 36415 was revised and code 36416 was added to better assign blood collection methods, and so that HCPCS Temporary G code G0001—routine venipuncture for collection of specimen(s)—could be deleted.

Excising skin lesions

Coders now choose which skin-lesion code to report based on the total amount of tissue removed at the site during the operative session, not just lesion size. These codes were revised so it’s clear they describe a full-thickness removal of the lesion, including the margin, along with simple closure (if performed).

• 11420 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less
  
• 11421 excised diameter 0.6 to 1.0 cm
  
• 11422 excised diameter 1.1 to 2.0 cm
  
• 11423 excised diameter 2.1 to 3.0 cm
  
• 11424 excised diameter 3.1 to 4.0 cm
  
• 11426 excised diameter over 4.0 cm
  
• 11620 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less
  
• 11621 excised diameter 0.6 to 1.0 cm
  
• 11622 excised diameter 1.1 to 2.0 cm
  
• 11623 excised diameter 2.1 to 3.0 cm
  
• 11624 excised diameter 3.1 to 4.0 cm
  
• 11626 excised diameter over 4.0 cm
  

Coding for new technology

Category III codes represent emerging technology, and several that may be of use to Ob/Gyns have been added. Note that payers may not yet reimburse for these procedures. These procedure codes are listed in the CPT book just prior to Appendix A.

When a Category III code accurately describes the procedure or service performed, use that code rather than an unlisted code. CPT adds Category III codes to its database in January and July. To check on any Category III code updates, go to www.amaassn.org/ama/pub/article/3885-4897.html:

 

• 0028T Dual energy x-ray absorptiometry (DEXA) body composition study, 1 or more sites.
  

This code represents the assessment of body fat composition—a procedure popular with athletes, but one unlikely to be covered by insurers in most cases. Its medical indications are generally children with growth disorders; adults with growth hormone deficiency; and patients with eating disorders, with rapid intervention or unintentional weight loss, or on long-term total parenteral nutrition.

• 0029T Treatment(s) for incontinence, pulsed magnetic neuromodula-tion, per day
  

This code would be used to report treatment with the NeoControl system (Neotonus, Inc., Marietta, Ga), in which the patient sits in a chair designed to induce contractions in the pelvic floor and urinary sphincter muscles via a pulsed magnetic field.

• 0030T Antiprothrombin (phospholipid cofactor) antibody, each Ig class
  

Code 0030T represents an antibody test to assess patients who may be at risk for, among other things, fetal loss.

• 0031T Speculoscopy;
  
• 0032T with directed sampling
  

These were added to report procedures, such as PapSure (Watson Diagnostics, Corona, Calif), in which light is used to examine the cervix for abnormal lesions and aid in specimen collection.

Ms. Witt reports no financial relationship with any companies whose products are mentioned in this article.

There’s good news and bad news for OBG coders in 2003. The bad news is that the wealth of new Current Procedural Terminology (CPT) codes means practices must make some serious changes to their office procedures encounter form. The good news is that these long-awaited changes should make it easier for physicians to communicate to insurers the type and difficulty of many routine procedures.

In addition to the OBG-relevant changes highlighted in this article, a wide range of other code and editorial updates have been made. For instance, CPT has deleted the optional 5-digit modifier codes that could have been used instead of the 2 digit modifier. (For example, CPT defined that the modifier to signify a separate and significant E/M service could be reported as either modifier -25 or by using the code 09925. With CPT 2003, only the modifier would be reported.) This change was necessary because the uniform electronic claim set up as a result of Health Insurance Portability and Accountability Act regulations can only accommodate 2-character modifiers. Coders should therefore review CPT 2003 in full to ensure that all relevant changes are captured.

A note about formatting: Codes marked in red are new in CPT 2003, while blue codes have been revised since the last edition. When a code has 1 or more indented codes following it, the indented text replaces everything following the semicolon in the initial code.

Updated pap smear codes

Pap smear codes have been revised to more clearly represent current screening techniques. Codes 88144 and 88145—which described the ThinPrep (Cytyc Corporation, Boxborough, Mass) manual screening and computer-assisted rescreening—have been deleted, but 2 new codes have been added:

• 88174 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision
  
• 88175 with screening by automated system and manual rescreening, under physician supervision
  

For manual screening, coders should refer to codes 88142 and 88143.

Counting leukocytes, testing semen

• 89055 leukocyte count, fecal
  

This new code, added to describe laboratory testing for fecal leukocytes, replaces the Health Care Financing Administrators Common Procedure Coding System (HCPCS) Level II G code G0026 (fecal leukocyte examination).

• 89300 Semen analysis; presence and/or motility of sperm including Huhner test (post coital);
  
• 89310 Motility and count, not including Huhner test.
  

While 89300 has not changed, 89310 was revised to specifically exclude Huhner testing. It will replace the HCPCS Level II G code G0027 (semen analysis presence and/or motility of sperm excluding Huhner test).

The biggest change: diagnostic ultrasound codes

Possibly the most significant change in CPT coding comes in the area of obstetric ultrasound. These codes have been revamped to allow maternal-fetal specialists to report accurately the ultrasound procedures they perform. A new guideline note that precedes this section gives a clear definition of what the codes in that section include. For instance, the guidelines state regarding 2 of the codes:

“Codes 76801 and 76802 include determination of the number of gestational sacs and fetuses, gestational sac/fetal measurements appropriate for gestation (

Coders should spend time reviewing this section to ensure correct billing. Please also note that the codes 76802, 76810 and 76812 are designated by CPT as “add-on” codes. This means that they do not require a modifier to indicate a multiple procedure (i.e., modifier-51):

• 76801 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (
• 76802 each additional gestation (List separately in addition to code for primary procedure performed.)
  

(Use 76802 in conjunction with 76801.)

• 76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (14 weeks 0 days), transabdominal approach; single or first gestation
  
• 76810 each additional gestation (List separately in addition to code for primary procedure performed.)
  

(Use 76810 in conjunction with 76805.)

• 76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation
  
• 76812 each additional gestation (List separately in addition to code for primary procedure performed.)
  

(Use 76812 in conjunction with 76811.)

 

• 76815 Ultrasound, pregnant uterus, real time with image documentation, limited (e.g., fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses
  

(Use 76815 only once per exam, not per element.)

• 76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up (e.g., reevaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, reevaluation of organ system[s] suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetus
  

(Report 76816 with modifier -59 [distinct procedure] for each additional fetus examined in a multiple pregnancy.)

• 76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal
  

(If transvaginal examination is done in addition to transabdominal obstetrical ultrasound exam, use 76817 as well as the appropriate transabdominal exam code. For nonobstetrical transvaginal ultrasound, use code 76830 [ultrasound, transvaginal].)

Multiple births. There has also been a change in CPT instructions for coding multiple fetuses when performing a fetal biophysical profile (BPP). In the past, CPT instructed coders to use modifier -51 (multiple procedures) with each BPP code reported at that session after the first fetus (e.g., 76818, 76818-51 for twins). Now CPT indicates that a BPP done on additional fetuses should be reported separately by adding the modifier -59 (distinct procedure) to code 76818 (fetal biophysical profile; with non-stress testing) or 76819 (fetal biophysical profile without non-stress testing).

Transvaginal examination. CPT now explicitly states that if a transvaginal examination is done in addition to a transabdominal gynecologic ultrasound exam, coders should use code 76830 in addition to the appropriate transabdominal exam code (76856-76857).

Bone density studies

CPT now differentiates between a study done on the axial skeleton and one done on the peripheral skeleton, thanks to the revision of 1 code and the addition of a second:

• 76070 Computed tomography, bone mineral density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine)
  
• 76071 appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
  

Vaginal hysterectomy

The codes listed below were revised or added to account for the additional work involved in removing a large uterus vaginally. Report these new codes when the operative report includes a description of how the uterus was removed—by bisection, morcellation, or myomectomy and coring—and confirms the weight of the uterus. As with an abdominal hysterectomy, fibroid removal prior to uterus removal is considered an integral part of the procedure, and therefore is not reported separately. Note that if the weight of the uterus is not known at the time the procedure is coded, the default would be to code for the uterus that weighs 250 g or less.

• 58550 Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 grams or less;
  
• 58552 with removal of tube(s) and/or ovary(s)
  
• 58553 Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 grams;
  
• 58554 with removal of tube(s) and/or ovary(s)
  
• 58260 Vaginal hysterectomy for uterus 250 grams or less;
  
• 58262 with removal of tube(s) and ovary(s)
  
• 58263 with removal of tube(s), and/or ovary(s), with repair of enterocele
  
• 58267 with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control
  
• 58270 with repair of enterocele
  
• 58290 Vaginal hysterectomy, for uterus greater than 250 grams;
  
• 58291 with removal of tube(s) and/or ovary(s)
  
• 58292 with removal of tube(s) and/or ovary(s), with repair of enterocele
  
• 58293 with colpo-urethrocysto-pexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control
  
• 58294 with repair of enterocele
  

Myomectomy

CPT changed the uterine-fibroid removal codes to account for the more involved surgical work required for larger or multiple fibroids:

• 58140 Myomectomy, excision of fibroid tumor(s) of uterus, 1 to 4 intramural myoma(s) with total weight of 250 grams or less and/or removal of surface myoma(s); abdominal approach
  
• 58145 vaginal approach
  
• 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
  

(Do not report 58146 in addition to 58140-58145 or 58150-58240 [abdominal hysterectomy codes].)

• 58545 Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight of 250 grams or less and/or removal of surface myomas
  
• 58546 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 grams
  

Coders should note that code 58551 (laparoscopy, surgical; with removal of leiomyomata [single or multiple]) has been deleted. In its place coders would report either 58545 or 58546. CPT has also clarified that the “abdominal approach” myomectomy codes should not be reported in addition to the abdominal hysterectomy codes (58150-58240).

Colposcopy procedures

CPT 2003 contains new and revised codes for colposcopy of the vulva, cervix, and vagina:

• 56820 Colposcopy of the vulva;
  
• 56821 with biopsy(s)
  
• 57420 Colposcopy of the entire vagina, with cervix if present;
  
• 57421 with biopsy(s)
  

 

(For cervicography, see Category III code 0003T.)

• 57452 Colposcopy of the cervix including upper/adjacent vagina;
  
• 57454 with biopsy(s) of the cervix and endocervical curettage
  
• 57455 with biopsy(s) of the cervix
  
• 57456 with endocervical curettage
  
• 57460 with loop electrode biopsy(s) of the cervix
  
• 57461 with loop electrode conization of the cervix
  

Coders should note the following guidelines:

• If colposcopy is performed on both the vagina and vulva, both procedures may be reported, with modifier -51 added to the code of lesser relative value.
  
• A superficial cervical examination is considered part of a complete vaginal examination (codes 57420 and 57421), if performed.
  
• If the main purpose of the examination is to evaluate the cervix, not the vagina, only the cervical colposcopy codes (54452-57461) would be reported.
  
• Colposcopy of the cervix codes (54452-57461) include an examination of the entire cervix as well as the upper/adjacent portion of the vagina.
  
• Code 57460 has been revised and code 57461 added to clarify the 2 different cervical loop electrode excision procedures that might be done in conjunction with colposcopy. Code 57460 includes removal of the exocervix and a portion of the transformation zone, if necessary. Code 57461 represents a conization procedure that takes all of the exocervix, the transformation zone, and some or all of the endocervix.
  
• An endocervical curettage is included as part of a conization; therefore code 57456 would not be reported in addition to code 57461.
  

Bladder procedures, incontinence testing

Three new codes were developed to replace HCPCS code G0002 (office procedure, insertion of temporary indwelling catheter, Foley type [separate procedure]). These would be reported only when the catheter insertion is an independent procedure, not part of another procedure.

Codes 53670 and 53675 (both catheterization procedures listed under the heading “urethra”) have been deleted. In their place are new codes that are more appropriate.

• 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)
  

Urodynamics. Code 51798 (measurement of postvoiding residual urine and/or bladder capacity by ultrasound, nonimaging) replaces code 78730, which had been inaccurately placed in CPT’s nuclear medicine section, as well as the HCPCS Level II G code G0050 (measurement of postvoiding residual urine and/or bladder capacity by ultrasound, nonimaging). The new code represents a more accurate description of this noninvasive procedure, which uses a handheld Doppler ultrasonic device. This code represents only the technical component of the procedure, and is not associated with physician work that involves interpretation because the device gives a numeric result.

Abdominal procedures

• 49419 Insertion of intraperitoneal cannula or catheter, with subcutaneous reservoir, permanent (i.e., totally implantable)
  

This would be reported by gynecologic oncologists who want to provide intraperitoneal chemotherapy in women with ovarian or primary peritoneal cancer. The procedure requires an incision and the creation of a pocket for the reservoir.

For the removal of these devices, use code 49422.

Blood collection

• 36415 Collection of venous blood by venipuncture
  
• 36416 Collection of capillary blood specimen (e.g., finger, heel, ear stick)
  

Code 36415 was revised and code 36416 was added to better assign blood collection methods, and so that HCPCS Temporary G code G0001—routine venipuncture for collection of specimen(s)—could be deleted.

Excising skin lesions

Coders now choose which skin-lesion code to report based on the total amount of tissue removed at the site during the operative session, not just lesion size. These codes were revised so it’s clear they describe a full-thickness removal of the lesion, including the margin, along with simple closure (if performed).

• 11420 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less
  
• 11421 excised diameter 0.6 to 1.0 cm
  
• 11422 excised diameter 1.1 to 2.0 cm
  
• 11423 excised diameter 2.1 to 3.0 cm
  
• 11424 excised diameter 3.1 to 4.0 cm
  
• 11426 excised diameter over 4.0 cm
  
• 11620 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less
  
• 11621 excised diameter 0.6 to 1.0 cm
  
• 11622 excised diameter 1.1 to 2.0 cm
  
• 11623 excised diameter 2.1 to 3.0 cm
  
• 11624 excised diameter 3.1 to 4.0 cm
  
• 11626 excised diameter over 4.0 cm
  

Coding for new technology

Category III codes represent emerging technology, and several that may be of use to Ob/Gyns have been added. Note that payers may not yet reimburse for these procedures. These procedure codes are listed in the CPT book just prior to Appendix A.

When a Category III code accurately describes the procedure or service performed, use that code rather than an unlisted code. CPT adds Category III codes to its database in January and July. To check on any Category III code updates, go to www.amaassn.org/ama/pub/article/3885-4897.html:

 

• 0028T Dual energy x-ray absorptiometry (DEXA) body composition study, 1 or more sites.
  

This code represents the assessment of body fat composition—a procedure popular with athletes, but one unlikely to be covered by insurers in most cases. Its medical indications are generally children with growth disorders; adults with growth hormone deficiency; and patients with eating disorders, with rapid intervention or unintentional weight loss, or on long-term total parenteral nutrition.

• 0029T Treatment(s) for incontinence, pulsed magnetic neuromodula-tion, per day
  

This code would be used to report treatment with the NeoControl system (Neotonus, Inc., Marietta, Ga), in which the patient sits in a chair designed to induce contractions in the pelvic floor and urinary sphincter muscles via a pulsed magnetic field.

• 0030T Antiprothrombin (phospholipid cofactor) antibody, each Ig class
  

Code 0030T represents an antibody test to assess patients who may be at risk for, among other things, fetal loss.

• 0031T Speculoscopy;
  
• 0032T with directed sampling
  

These were added to report procedures, such as PapSure (Watson Diagnostics, Corona, Calif), in which light is used to examine the cervix for abnormal lesions and aid in specimen collection.

Ms. Witt reports no financial relationship with any companies whose products are mentioned in this article.

There’s good news and bad news for OBG coders in 2003. The bad news is that the wealth of new Current Procedural Terminology (CPT) codes means practices must make some serious changes to their office procedures encounter form. The good news is that these long-awaited changes should make it easier for physicians to communicate to insurers the type and difficulty of many routine procedures.

In addition to the OBG-relevant changes highlighted in this article, a wide range of other code and editorial updates have been made. For instance, CPT has deleted the optional 5-digit modifier codes that could have been used instead of the 2 digit modifier. (For example, CPT defined that the modifier to signify a separate and significant E/M service could be reported as either modifier -25 or by using the code 09925. With CPT 2003, only the modifier would be reported.) This change was necessary because the uniform electronic claim set up as a result of Health Insurance Portability and Accountability Act regulations can only accommodate 2-character modifiers. Coders should therefore review CPT 2003 in full to ensure that all relevant changes are captured.

A note about formatting: Codes marked in red are new in CPT 2003, while blue codes have been revised since the last edition. When a code has 1 or more indented codes following it, the indented text replaces everything following the semicolon in the initial code.

Updated pap smear codes

Pap smear codes have been revised to more clearly represent current screening techniques. Codes 88144 and 88145—which described the ThinPrep (Cytyc Corporation, Boxborough, Mass) manual screening and computer-assisted rescreening—have been deleted, but 2 new codes have been added:

• 88174 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision
  
• 88175 with screening by automated system and manual rescreening, under physician supervision
  

For manual screening, coders should refer to codes 88142 and 88143.

Counting leukocytes, testing semen

• 89055 leukocyte count, fecal
  

This new code, added to describe laboratory testing for fecal leukocytes, replaces the Health Care Financing Administrators Common Procedure Coding System (HCPCS) Level II G code G0026 (fecal leukocyte examination).

• 89300 Semen analysis; presence and/or motility of sperm including Huhner test (post coital);
  
• 89310 Motility and count, not including Huhner test.
  

While 89300 has not changed, 89310 was revised to specifically exclude Huhner testing. It will replace the HCPCS Level II G code G0027 (semen analysis presence and/or motility of sperm excluding Huhner test).

The biggest change: diagnostic ultrasound codes

Possibly the most significant change in CPT coding comes in the area of obstetric ultrasound. These codes have been revamped to allow maternal-fetal specialists to report accurately the ultrasound procedures they perform. A new guideline note that precedes this section gives a clear definition of what the codes in that section include. For instance, the guidelines state regarding 2 of the codes:

“Codes 76801 and 76802 include determination of the number of gestational sacs and fetuses, gestational sac/fetal measurements appropriate for gestation (

Coders should spend time reviewing this section to ensure correct billing. Please also note that the codes 76802, 76810 and 76812 are designated by CPT as “add-on” codes. This means that they do not require a modifier to indicate a multiple procedure (i.e., modifier-51):

• 76801 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (
• 76802 each additional gestation (List separately in addition to code for primary procedure performed.)
  

(Use 76802 in conjunction with 76801.)

• 76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (14 weeks 0 days), transabdominal approach; single or first gestation
  
• 76810 each additional gestation (List separately in addition to code for primary procedure performed.)
  

(Use 76810 in conjunction with 76805.)

• 76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation
  
• 76812 each additional gestation (List separately in addition to code for primary procedure performed.)
  

(Use 76812 in conjunction with 76811.)

 

• 76815 Ultrasound, pregnant uterus, real time with image documentation, limited (e.g., fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses
  

(Use 76815 only once per exam, not per element.)

• 76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up (e.g., reevaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, reevaluation of organ system[s] suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetus
  

(Report 76816 with modifier -59 [distinct procedure] for each additional fetus examined in a multiple pregnancy.)

• 76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal
  

(If transvaginal examination is done in addition to transabdominal obstetrical ultrasound exam, use 76817 as well as the appropriate transabdominal exam code. For nonobstetrical transvaginal ultrasound, use code 76830 [ultrasound, transvaginal].)

Multiple births. There has also been a change in CPT instructions for coding multiple fetuses when performing a fetal biophysical profile (BPP). In the past, CPT instructed coders to use modifier -51 (multiple procedures) with each BPP code reported at that session after the first fetus (e.g., 76818, 76818-51 for twins). Now CPT indicates that a BPP done on additional fetuses should be reported separately by adding the modifier -59 (distinct procedure) to code 76818 (fetal biophysical profile; with non-stress testing) or 76819 (fetal biophysical profile without non-stress testing).

Transvaginal examination. CPT now explicitly states that if a transvaginal examination is done in addition to a transabdominal gynecologic ultrasound exam, coders should use code 76830 in addition to the appropriate transabdominal exam code (76856-76857).

Bone density studies

CPT now differentiates between a study done on the axial skeleton and one done on the peripheral skeleton, thanks to the revision of 1 code and the addition of a second:

• 76070 Computed tomography, bone mineral density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine)
  
• 76071 appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
  

Vaginal hysterectomy

The codes listed below were revised or added to account for the additional work involved in removing a large uterus vaginally. Report these new codes when the operative report includes a description of how the uterus was removed—by bisection, morcellation, or myomectomy and coring—and confirms the weight of the uterus. As with an abdominal hysterectomy, fibroid removal prior to uterus removal is considered an integral part of the procedure, and therefore is not reported separately. Note that if the weight of the uterus is not known at the time the procedure is coded, the default would be to code for the uterus that weighs 250 g or less.

• 58550 Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 grams or less;
  
• 58552 with removal of tube(s) and/or ovary(s)
  
• 58553 Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 grams;
  
• 58554 with removal of tube(s) and/or ovary(s)
  
• 58260 Vaginal hysterectomy for uterus 250 grams or less;
  
• 58262 with removal of tube(s) and ovary(s)
  
• 58263 with removal of tube(s), and/or ovary(s), with repair of enterocele
  
• 58267 with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control
  
• 58270 with repair of enterocele
  
• 58290 Vaginal hysterectomy, for uterus greater than 250 grams;
  
• 58291 with removal of tube(s) and/or ovary(s)
  
• 58292 with removal of tube(s) and/or ovary(s), with repair of enterocele
  
• 58293 with colpo-urethrocysto-pexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control
  
• 58294 with repair of enterocele
  

Myomectomy

CPT changed the uterine-fibroid removal codes to account for the more involved surgical work required for larger or multiple fibroids:

• 58140 Myomectomy, excision of fibroid tumor(s) of uterus, 1 to 4 intramural myoma(s) with total weight of 250 grams or less and/or removal of surface myoma(s); abdominal approach
  
• 58145 vaginal approach
  
• 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
  

(Do not report 58146 in addition to 58140-58145 or 58150-58240 [abdominal hysterectomy codes].)

• 58545 Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight of 250 grams or less and/or removal of surface myomas
  
• 58546 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 grams
  

Coders should note that code 58551 (laparoscopy, surgical; with removal of leiomyomata [single or multiple]) has been deleted. In its place coders would report either 58545 or 58546. CPT has also clarified that the “abdominal approach” myomectomy codes should not be reported in addition to the abdominal hysterectomy codes (58150-58240).

Colposcopy procedures

CPT 2003 contains new and revised codes for colposcopy of the vulva, cervix, and vagina:

• 56820 Colposcopy of the vulva;
  
• 56821 with biopsy(s)
  
• 57420 Colposcopy of the entire vagina, with cervix if present;
  
• 57421 with biopsy(s)
  

 

(For cervicography, see Category III code 0003T.)

• 57452 Colposcopy of the cervix including upper/adjacent vagina;
  
• 57454 with biopsy(s) of the cervix and endocervical curettage
  
• 57455 with biopsy(s) of the cervix
  
• 57456 with endocervical curettage
  
• 57460 with loop electrode biopsy(s) of the cervix
  
• 57461 with loop electrode conization of the cervix
  

Coders should note the following guidelines:

• If colposcopy is performed on both the vagina and vulva, both procedures may be reported, with modifier -51 added to the code of lesser relative value.
  
• A superficial cervical examination is considered part of a complete vaginal examination (codes 57420 and 57421), if performed.
  
• If the main purpose of the examination is to evaluate the cervix, not the vagina, only the cervical colposcopy codes (54452-57461) would be reported.
  
• Colposcopy of the cervix codes (54452-57461) include an examination of the entire cervix as well as the upper/adjacent portion of the vagina.
  
• Code 57460 has been revised and code 57461 added to clarify the 2 different cervical loop electrode excision procedures that might be done in conjunction with colposcopy. Code 57460 includes removal of the exocervix and a portion of the transformation zone, if necessary. Code 57461 represents a conization procedure that takes all of the exocervix, the transformation zone, and some or all of the endocervix.
  
• An endocervical curettage is included as part of a conization; therefore code 57456 would not be reported in addition to code 57461.
  

Bladder procedures, incontinence testing

Three new codes were developed to replace HCPCS code G0002 (office procedure, insertion of temporary indwelling catheter, Foley type [separate procedure]). These would be reported only when the catheter insertion is an independent procedure, not part of another procedure.

Codes 53670 and 53675 (both catheterization procedures listed under the heading “urethra”) have been deleted. In their place are new codes that are more appropriate.

• 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)
  

Urodynamics. Code 51798 (measurement of postvoiding residual urine and/or bladder capacity by ultrasound, nonimaging) replaces code 78730, which had been inaccurately placed in CPT’s nuclear medicine section, as well as the HCPCS Level II G code G0050 (measurement of postvoiding residual urine and/or bladder capacity by ultrasound, nonimaging). The new code represents a more accurate description of this noninvasive procedure, which uses a handheld Doppler ultrasonic device. This code represents only the technical component of the procedure, and is not associated with physician work that involves interpretation because the device gives a numeric result.

Abdominal procedures

• 49419 Insertion of intraperitoneal cannula or catheter, with subcutaneous reservoir, permanent (i.e., totally implantable)
  

This would be reported by gynecologic oncologists who want to provide intraperitoneal chemotherapy in women with ovarian or primary peritoneal cancer. The procedure requires an incision and the creation of a pocket for the reservoir.

For the removal of these devices, use code 49422.

Blood collection

• 36415 Collection of venous blood by venipuncture
  
• 36416 Collection of capillary blood specimen (e.g., finger, heel, ear stick)
  

Code 36415 was revised and code 36416 was added to better assign blood collection methods, and so that HCPCS Temporary G code G0001—routine venipuncture for collection of specimen(s)—could be deleted.

Excising skin lesions

Coders now choose which skin-lesion code to report based on the total amount of tissue removed at the site during the operative session, not just lesion size. These codes were revised so it’s clear they describe a full-thickness removal of the lesion, including the margin, along with simple closure (if performed).

• 11420 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less
  
• 11421 excised diameter 0.6 to 1.0 cm
  
• 11422 excised diameter 1.1 to 2.0 cm
  
• 11423 excised diameter 2.1 to 3.0 cm
  
• 11424 excised diameter 3.1 to 4.0 cm
  
• 11426 excised diameter over 4.0 cm
  
• 11620 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less
  
• 11621 excised diameter 0.6 to 1.0 cm
  
• 11622 excised diameter 1.1 to 2.0 cm
  
• 11623 excised diameter 2.1 to 3.0 cm
  
• 11624 excised diameter 3.1 to 4.0 cm
  
• 11626 excised diameter over 4.0 cm
  

Coding for new technology

Category III codes represent emerging technology, and several that may be of use to Ob/Gyns have been added. Note that payers may not yet reimburse for these procedures. These procedure codes are listed in the CPT book just prior to Appendix A.

When a Category III code accurately describes the procedure or service performed, use that code rather than an unlisted code. CPT adds Category III codes to its database in January and July. To check on any Category III code updates, go to www.amaassn.org/ama/pub/article/3885-4897.html:

 

• 0028T Dual energy x-ray absorptiometry (DEXA) body composition study, 1 or more sites.
  

This code represents the assessment of body fat composition—a procedure popular with athletes, but one unlikely to be covered by insurers in most cases. Its medical indications are generally children with growth disorders; adults with growth hormone deficiency; and patients with eating disorders, with rapid intervention or unintentional weight loss, or on long-term total parenteral nutrition.

• 0029T Treatment(s) for incontinence, pulsed magnetic neuromodula-tion, per day
  

This code would be used to report treatment with the NeoControl system (Neotonus, Inc., Marietta, Ga), in which the patient sits in a chair designed to induce contractions in the pelvic floor and urinary sphincter muscles via a pulsed magnetic field.

• 0030T Antiprothrombin (phospholipid cofactor) antibody, each Ig class
  

Code 0030T represents an antibody test to assess patients who may be at risk for, among other things, fetal loss.

• 0031T Speculoscopy;
  
• 0032T with directed sampling
  

These were added to report procedures, such as PapSure (Watson Diagnostics, Corona, Calif), in which light is used to examine the cervix for abnormal lesions and aid in specimen collection.

Ms. Witt reports no financial relationship with any companies whose products are mentioned in this article.

Q Is there any additional billing when a fetal scalp pH is taken at the time of delivery?

A CPT lists code 59030 (fetal scalp blood sampling) as a billable service outside of the global obstetric package. However, some payers may decide this test is inessential if your documentation does not support its medical necessity. Be sure, therefore, that your diagnostic coding is in order.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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 Is there any additional billing when a fetal scalp pH is taken at the time of delivery?

A CPT lists code 59030 (fetal scalp blood sampling) as a billable service outside of the global obstetric package. However, some payers may decide this test is inessential if your documentation does not support its medical necessity. Be sure, therefore, that your diagnostic coding is in order.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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 Is there any additional billing when a fetal scalp pH is taken at the time of delivery?

A CPT lists code 59030 (fetal scalp blood sampling) as a billable service outside of the global obstetric package. However, some payers may decide this test is inessential if your documentation does not support its medical necessity. Be sure, therefore, that your diagnostic coding is in order.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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 a doctor performs a laparoscopy-assisted vaginal hysterectomy (LAVH) with removal of leiomyomata, which procedure code is correct: 58550 or 58551?

A CPT describes code 58550 as an LAVH, and code 58551 as laparoscopic removal of leiomyoma (i.e., fibroids). Because most fibroids are attached to the uterus you are removing, you should only code for the hysterectomy. If a fibroid in some other location was removed or if overly large fibroids complicated the surgery, you could code the myomectomy separately—just be sure to send a note with the claim and operative report verifying that this was a procedure distinct from the uterus removal.

Note, however, that both these codes have been altered in CPT 2003. Specifically, code 58551 has been deleted, with 2 new codes (58545 and 58546) replacing it. Coding for fibroid removal will now be dependent on the number of fibroids (less than 5 versus 5 or more), and their weight.

Code 58550, meanwhile, was revised, and 3 new codes were added (58552, 58553, and 58554) to account for the weight of the uterus. If this surgery occurred in 2003, the code used could be affected if the fibroids increased the size of the uterus. Code 58550 would be selected for a uterus of 250 g or less, code 58552 for a uterus 250 g or less with removal of tubes and ovaries, code 58553 for a uterus of more than 250 g, and code 58554 for a uterus over 250 g with removal of tubes and ovaries.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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 a doctor performs a laparoscopy-assisted vaginal hysterectomy (LAVH) with removal of leiomyomata, which procedure code is correct: 58550 or 58551?

A CPT describes code 58550 as an LAVH, and code 58551 as laparoscopic removal of leiomyoma (i.e., fibroids). Because most fibroids are attached to the uterus you are removing, you should only code for the hysterectomy. If a fibroid in some other location was removed or if overly large fibroids complicated the surgery, you could code the myomectomy separately—just be sure to send a note with the claim and operative report verifying that this was a procedure distinct from the uterus removal.

Note, however, that both these codes have been altered in CPT 2003. Specifically, code 58551 has been deleted, with 2 new codes (58545 and 58546) replacing it. Coding for fibroid removal will now be dependent on the number of fibroids (less than 5 versus 5 or more), and their weight.

Code 58550, meanwhile, was revised, and 3 new codes were added (58552, 58553, and 58554) to account for the weight of the uterus. If this surgery occurred in 2003, the code used could be affected if the fibroids increased the size of the uterus. Code 58550 would be selected for a uterus of 250 g or less, code 58552 for a uterus 250 g or less with removal of tubes and ovaries, code 58553 for a uterus of more than 250 g, and code 58554 for a uterus over 250 g with removal of tubes and ovaries.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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 a doctor performs a laparoscopy-assisted vaginal hysterectomy (LAVH) with removal of leiomyomata, which procedure code is correct: 58550 or 58551?

A CPT describes code 58550 as an LAVH, and code 58551 as laparoscopic removal of leiomyoma (i.e., fibroids). Because most fibroids are attached to the uterus you are removing, you should only code for the hysterectomy. If a fibroid in some other location was removed or if overly large fibroids complicated the surgery, you could code the myomectomy separately—just be sure to send a note with the claim and operative report verifying that this was a procedure distinct from the uterus removal.

Note, however, that both these codes have been altered in CPT 2003. Specifically, code 58551 has been deleted, with 2 new codes (58545 and 58546) replacing it. Coding for fibroid removal will now be dependent on the number of fibroids (less than 5 versus 5 or more), and their weight.

Code 58550, meanwhile, was revised, and 3 new codes were added (58552, 58553, and 58554) to account for the weight of the uterus. If this surgery occurred in 2003, the code used could be affected if the fibroids increased the size of the uterus. Code 58550 would be selected for a uterus of 250 g or less, code 58552 for a uterus 250 g or less with removal of tubes and ovaries, code 58553 for a uterus of more than 250 g, and code 58554 for a uterus over 250 g with removal of tubes and ovaries.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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 Our nurse performs urodynamic testing in our office (CPT codes 51772, 51726-51, and 51741-51), which we bill globally, since our physician interprets the tests. Is the followup appointment (when the patient comes back for the test results, discussion of treatment options, etc.) a billable evaluation and management (E/M) visit or is it included in the urodynamics charge?

A All of the codes you cited have 0 global days, per the Medicare resource-based relative value scale, which means they include only services related to the urodynamic test on the day it is performed. If the patient returns to discuss results and treatment options, the visit is billed as an E/M service. In most cases, this visit will consist of counseling. You therefore could meet the CPT requirement that says if counseling dominates the encounter, you can pick your E/M service based on the typical time detailed in the code description. Just be sure the physician indicates the content of the counseling and the time it took, so that the correct level of E/M service can be selected.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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 Our nurse performs urodynamic testing in our office (CPT codes 51772, 51726-51, and 51741-51), which we bill globally, since our physician interprets the tests. Is the followup appointment (when the patient comes back for the test results, discussion of treatment options, etc.) a billable evaluation and management (E/M) visit or is it included in the urodynamics charge?

A All of the codes you cited have 0 global days, per the Medicare resource-based relative value scale, which means they include only services related to the urodynamic test on the day it is performed. If the patient returns to discuss results and treatment options, the visit is billed as an E/M service. In most cases, this visit will consist of counseling. You therefore could meet the CPT requirement that says if counseling dominates the encounter, you can pick your E/M service based on the typical time detailed in the code description. Just be sure the physician indicates the content of the counseling and the time it took, so that the correct level of E/M service can be selected.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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 Our nurse performs urodynamic testing in our office (CPT codes 51772, 51726-51, and 51741-51), which we bill globally, since our physician interprets the tests. Is the followup appointment (when the patient comes back for the test results, discussion of treatment options, etc.) a billable evaluation and management (E/M) visit or is it included in the urodynamics charge?

A All of the codes you cited have 0 global days, per the Medicare resource-based relative value scale, which means they include only services related to the urodynamic test on the day it is performed. If the patient returns to discuss results and treatment options, the visit is billed as an E/M service. In most cases, this visit will consist of counseling. You therefore could meet the CPT requirement that says if counseling dominates the encounter, you can pick your E/M service based on the typical time detailed in the code description. Just be sure the physician indicates the content of the counseling and the time it took, so that the correct level of E/M service can be selected.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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.