Reimbursement Advisor

Q Some of our physicians are billing for a level 2 or 3 counseling visit when they discuss the test results of sonohysterograms immediately after the procedure. Is this legitimate, or is patient counseling included in the sonohysterography codes?

A The sonohysterography codes, both for the injection of the saline (58340) and the radiologic supervision (76831), only include obtaining informed consent or telling the patient what to expect during the procedure, not patient counseling. Therefore, the physician also may bill for an E/M service, which encompasses a discussion of the results and appropriate follow-up. In addition, include the modifier-25 to indicate that the counseling was a significant, separate E/M service that took place on the same day as the procedure.

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 Some of our physicians are billing for a level 2 or 3 counseling visit when they discuss the test results of sonohysterograms immediately after the procedure. Is this legitimate, or is patient counseling included in the sonohysterography codes?

A The sonohysterography codes, both for the injection of the saline (58340) and the radiologic supervision (76831), only include obtaining informed consent or telling the patient what to expect during the procedure, not patient counseling. Therefore, the physician also may bill for an E/M service, which encompasses a discussion of the results and appropriate follow-up. In addition, include the modifier-25 to indicate that the counseling was a significant, separate E/M service that took place on the same day as the procedure.

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 Some of our physicians are billing for a level 2 or 3 counseling visit when they discuss the test results of sonohysterograms immediately after the procedure. Is this legitimate, or is patient counseling included in the sonohysterography codes?

A The sonohysterography codes, both for the injection of the saline (58340) and the radiologic supervision (76831), only include obtaining informed consent or telling the patient what to expect during the procedure, not patient counseling. Therefore, the physician also may bill for an E/M service, which encompasses a discussion of the results and appropriate follow-up. In addition, include the modifier-25 to indicate that the counseling was a significant, separate E/M service that took place on the same day as the procedure.

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 A payer wants our office to use the global obstetric code (59400) with the modifier-22 for a patient who switched insurance carriers mid-pregnancy so that another insurance company will be responsible for a portion of the bills. The company also wants us to attach a comment to the claim indicating how many times the patient was seen and the amount of reimbursement from the first insurance carrier. Is this proper?

A No, the insurance company’s recommendations represent inappropriate coding practices. Conventionally, when a patient changes insurance companies mid-pregnancy, the global obstetric code becomes obsolete. Why? Billing for the antepartum visits must be divided between 2 different insurers. Instead, use the code 59425 (4 to 6 antepartum visits) or code 59427 (7+ antepartum visits) to bill each carrier separately and then bill the current payer for the delivery and post-partum care using the code 59410, if it is an uncomplicated vaginal delivery.

Further, the modifier-22 indicates that an unusual service was provided or the course of the pregnancy/delivery/postpartum was complicated. As this is not the case, the insurer’s recommendations do not make sense.

My advice: Get the payer’s requests in writing and inform the insurance plan’s medical director about the recommendations, as well as the implications for incorrect coding.

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 A payer wants our office to use the global obstetric code (59400) with the modifier-22 for a patient who switched insurance carriers mid-pregnancy so that another insurance company will be responsible for a portion of the bills. The company also wants us to attach a comment to the claim indicating how many times the patient was seen and the amount of reimbursement from the first insurance carrier. Is this proper?

A No, the insurance company’s recommendations represent inappropriate coding practices. Conventionally, when a patient changes insurance companies mid-pregnancy, the global obstetric code becomes obsolete. Why? Billing for the antepartum visits must be divided between 2 different insurers. Instead, use the code 59425 (4 to 6 antepartum visits) or code 59427 (7+ antepartum visits) to bill each carrier separately and then bill the current payer for the delivery and post-partum care using the code 59410, if it is an uncomplicated vaginal delivery.

Further, the modifier-22 indicates that an unusual service was provided or the course of the pregnancy/delivery/postpartum was complicated. As this is not the case, the insurer’s recommendations do not make sense.

My advice: Get the payer’s requests in writing and inform the insurance plan’s medical director about the recommendations, as well as the implications for incorrect coding.

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 A payer wants our office to use the global obstetric code (59400) with the modifier-22 for a patient who switched insurance carriers mid-pregnancy so that another insurance company will be responsible for a portion of the bills. The company also wants us to attach a comment to the claim indicating how many times the patient was seen and the amount of reimbursement from the first insurance carrier. Is this proper?

A No, the insurance company’s recommendations represent inappropriate coding practices. Conventionally, when a patient changes insurance companies mid-pregnancy, the global obstetric code becomes obsolete. Why? Billing for the antepartum visits must be divided between 2 different insurers. Instead, use the code 59425 (4 to 6 antepartum visits) or code 59427 (7+ antepartum visits) to bill each carrier separately and then bill the current payer for the delivery and post-partum care using the code 59410, if it is an uncomplicated vaginal delivery.

Further, the modifier-22 indicates that an unusual service was provided or the course of the pregnancy/delivery/postpartum was complicated. As this is not the case, the insurer’s recommendations do not make sense.

My advice: Get the payer’s requests in writing and inform the insurance plan’s medical director about the recommendations, as well as the implications for incorrect coding.

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 It is our understanding that if a gravida is in the emergency room (ER) triage for less than 6 hours, we should bill an office visit/out-patient facility E/M code. Why not report an ER E/M visit unless the patient is admitted to observation status?

A Multiple problems arise when using the ER E/M codes (99281 to 99285), making the office visit/outpatient facility E/M codes a better alternative (99201 to 99215).

First, a payer may require that you prove it was an emergency, thereby slowing payment. Second, to report an ER code, you must document all 3 of the key components (history, exam, and medical decision-making), and you cannot use time as a default if any counseling or coordination of care took place. Third, the service must have been rendered in the ER; labor and delivery (L&D) does not qualify as an emergency department, even though that may be where all pregnant patients are sent. Fourth, the ER codes usually do not pay that well, especially since the physician may have only performed a problem-focused exam on the patient. This means that only a level 1 service can be billed because the lowest level of any of the 3 key components determines the level of service.

For these reasons, many physicians have decided simply to bill for the outpatient E/M service, and if the time with the patient was prolonged due to her condition, they bill for the additional time using the CPT “prolonged services” codes, provided that the time spent and medical necessity for the service have been documented in the patient’s medical record.

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 It is our understanding that if a gravida is in the emergency room (ER) triage for less than 6 hours, we should bill an office visit/out-patient facility E/M code. Why not report an ER E/M visit unless the patient is admitted to observation status?

A Multiple problems arise when using the ER E/M codes (99281 to 99285), making the office visit/outpatient facility E/M codes a better alternative (99201 to 99215).

First, a payer may require that you prove it was an emergency, thereby slowing payment. Second, to report an ER code, you must document all 3 of the key components (history, exam, and medical decision-making), and you cannot use time as a default if any counseling or coordination of care took place. Third, the service must have been rendered in the ER; labor and delivery (L&D) does not qualify as an emergency department, even though that may be where all pregnant patients are sent. Fourth, the ER codes usually do not pay that well, especially since the physician may have only performed a problem-focused exam on the patient. This means that only a level 1 service can be billed because the lowest level of any of the 3 key components determines the level of service.

For these reasons, many physicians have decided simply to bill for the outpatient E/M service, and if the time with the patient was prolonged due to her condition, they bill for the additional time using the CPT “prolonged services” codes, provided that the time spent and medical necessity for the service have been documented in the patient’s medical record.

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 It is our understanding that if a gravida is in the emergency room (ER) triage for less than 6 hours, we should bill an office visit/out-patient facility E/M code. Why not report an ER E/M visit unless the patient is admitted to observation status?

A Multiple problems arise when using the ER E/M codes (99281 to 99285), making the office visit/outpatient facility E/M codes a better alternative (99201 to 99215).

First, a payer may require that you prove it was an emergency, thereby slowing payment. Second, to report an ER code, you must document all 3 of the key components (history, exam, and medical decision-making), and you cannot use time as a default if any counseling or coordination of care took place. Third, the service must have been rendered in the ER; labor and delivery (L&D) does not qualify as an emergency department, even though that may be where all pregnant patients are sent. Fourth, the ER codes usually do not pay that well, especially since the physician may have only performed a problem-focused exam on the patient. This means that only a level 1 service can be billed because the lowest level of any of the 3 key components determines the level of service.

For these reasons, many physicians have decided simply to bill for the outpatient E/M service, and if the time with the patient was prolonged due to her condition, they bill for the additional time using the CPT “prolonged services” codes, provided that the time spent and medical necessity for the service have been documented in the patient’s medical record.

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 practice is debating which code we should report for the placement of a suprapubic catheter—51010 or 51040. What is the difference between the 2?

A The code 51010 (aspiration of bladder; with insertion of suprapubic catheter) is preferred. It refers to the transabdominal placement of a specially designed suprapubic catheter; the aspiration confirms proper placement of the device within the bladder.

The code 51040 (cystotomy, cystotomy with drainage) is used less frequently, usually in conjunction with an abdominal Burch procedure. In this case, the surgeon performs a cystotomy to inspect the lumen of the bladder for any misplaced sutures. Then, he or she inserts a drainage catheter through the cystotomy incision and sutures it around the catheter.

It is important to note that some payers will not reimburse for a procedure that involves checking for suture placement (e.g., cystotomy) because it is considered a standard surgical technique. However, catheter placement is necessary to prevent urinary retention and is a separately billable part of the procedure (51010).

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 practice is debating which code we should report for the placement of a suprapubic catheter—51010 or 51040. What is the difference between the 2?

A The code 51010 (aspiration of bladder; with insertion of suprapubic catheter) is preferred. It refers to the transabdominal placement of a specially designed suprapubic catheter; the aspiration confirms proper placement of the device within the bladder.

The code 51040 (cystotomy, cystotomy with drainage) is used less frequently, usually in conjunction with an abdominal Burch procedure. In this case, the surgeon performs a cystotomy to inspect the lumen of the bladder for any misplaced sutures. Then, he or she inserts a drainage catheter through the cystotomy incision and sutures it around the catheter.

It is important to note that some payers will not reimburse for a procedure that involves checking for suture placement (e.g., cystotomy) because it is considered a standard surgical technique. However, catheter placement is necessary to prevent urinary retention and is a separately billable part of the procedure (51010).

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 practice is debating which code we should report for the placement of a suprapubic catheter—51010 or 51040. What is the difference between the 2?

A The code 51010 (aspiration of bladder; with insertion of suprapubic catheter) is preferred. It refers to the transabdominal placement of a specially designed suprapubic catheter; the aspiration confirms proper placement of the device within the bladder.

The code 51040 (cystotomy, cystotomy with drainage) is used less frequently, usually in conjunction with an abdominal Burch procedure. In this case, the surgeon performs a cystotomy to inspect the lumen of the bladder for any misplaced sutures. Then, he or she inserts a drainage catheter through the cystotomy incision and sutures it around the catheter.

It is important to note that some payers will not reimburse for a procedure that involves checking for suture placement (e.g., cystotomy) because it is considered a standard surgical technique. However, catheter placement is necessary to prevent urinary retention and is a separately billable part of the procedure (51010).

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 Which CPT and ICD-9 codes should we use for the reversal of a ritual circumcision, i.e., female genital mutilation?

A First, report any symptoms or scarring the patient has. For example, possible codes include 623.2 (stricture or atresia of the vagina), 624.4 (old laceration or scarring of the vulva), or 624.8 (other specified noninflammatory disorders of the vulva and perineum). (The code V50.2 [routine or ritual circumcision] is inappropriate as it applies to male circumcision only.)

For the surgery itself, the repair codes are best because the physician first creates the defect (incision) and then repairs it. Look at codes 12001 to 12007, 12041 to 12047, and 13131 to 13133, or consider 56800 (plastic repair of the introitus) if more extensive repair work was performed. If there are labial adhesions, use the code 56441. The code 58999 can be used as a backup, as circumcision reversal may truly be an unlisted procedure. Always submit documentation with 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 Which CPT and ICD-9 codes should we use for the reversal of a ritual circumcision, i.e., female genital mutilation?

A First, report any symptoms or scarring the patient has. For example, possible codes include 623.2 (stricture or atresia of the vagina), 624.4 (old laceration or scarring of the vulva), or 624.8 (other specified noninflammatory disorders of the vulva and perineum). (The code V50.2 [routine or ritual circumcision] is inappropriate as it applies to male circumcision only.)

For the surgery itself, the repair codes are best because the physician first creates the defect (incision) and then repairs it. Look at codes 12001 to 12007, 12041 to 12047, and 13131 to 13133, or consider 56800 (plastic repair of the introitus) if more extensive repair work was performed. If there are labial adhesions, use the code 56441. The code 58999 can be used as a backup, as circumcision reversal may truly be an unlisted procedure. Always submit documentation with 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 Which CPT and ICD-9 codes should we use for the reversal of a ritual circumcision, i.e., female genital mutilation?

A First, report any symptoms or scarring the patient has. For example, possible codes include 623.2 (stricture or atresia of the vagina), 624.4 (old laceration or scarring of the vulva), or 624.8 (other specified noninflammatory disorders of the vulva and perineum). (The code V50.2 [routine or ritual circumcision] is inappropriate as it applies to male circumcision only.)

For the surgery itself, the repair codes are best because the physician first creates the defect (incision) and then repairs it. Look at codes 12001 to 12007, 12041 to 12047, and 13131 to 13133, or consider 56800 (plastic repair of the introitus) if more extensive repair work was performed. If there are labial adhesions, use the code 56441. The code 58999 can be used as a backup, as circumcision reversal may truly be an unlisted procedure. Always submit documentation with 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 Please clarify which codes we should use to bill for diagnostic testing (imaging tests and laboratory workups) for infertility. We currently use the code category 628.X; is the code V26.1 more appropriate?

A No, because it denotes a treatment for infertility (artificial insemination), not diagnostic testing. Further, the 628.X codes (infertility, female) should be used only when you have confirmed that the infertility is caused by the woman, not the male partner.

To appropriately bill for the diagnostic testing, use the code V26.21 (fertility testing) or V26.39 (other investigation and testing). While the former lists only fallopian tube insufflation and sperm count testing as specific examples, this code can be used to bill for any type of testing performed for infertility.

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 Please clarify which codes we should use to bill for diagnostic testing (imaging tests and laboratory workups) for infertility. We currently use the code category 628.X; is the code V26.1 more appropriate?

A No, because it denotes a treatment for infertility (artificial insemination), not diagnostic testing. Further, the 628.X codes (infertility, female) should be used only when you have confirmed that the infertility is caused by the woman, not the male partner.

To appropriately bill for the diagnostic testing, use the code V26.21 (fertility testing) or V26.39 (other investigation and testing). While the former lists only fallopian tube insufflation and sperm count testing as specific examples, this code can be used to bill for any type of testing performed for infertility.

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 Please clarify which codes we should use to bill for diagnostic testing (imaging tests and laboratory workups) for infertility. We currently use the code category 628.X; is the code V26.1 more appropriate?

A No, because it denotes a treatment for infertility (artificial insemination), not diagnostic testing. Further, the 628.X codes (infertility, female) should be used only when you have confirmed that the infertility is caused by the woman, not the male partner.

To appropriately bill for the diagnostic testing, use the code V26.21 (fertility testing) or V26.39 (other investigation and testing). While the former lists only fallopian tube insufflation and sperm count testing as specific examples, this code can be used to bill for any type of testing performed for infertility.

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 best way to code for parvovirus in pregnancy?

A If an IgG-negative gravida who was exposed to the disease seroconverted to IgG positive, assign the code 647.63 (other infectious and parasitic conditions in the mother classifiable elsewhere, but complicating pregnancy, childbirth, or the puerperium; antepartum condition) plus 057.0 to indicate parvovirus. Always list the pregnancy code first.

If an IgG-positive gravida was simply exposed to the virus, use the code V23.89 (other high-risk pregnancy) plus V01.7 (contact with or exposure to other viral diseases).

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 best way to code for parvovirus in pregnancy?

A If an IgG-negative gravida who was exposed to the disease seroconverted to IgG positive, assign the code 647.63 (other infectious and parasitic conditions in the mother classifiable elsewhere, but complicating pregnancy, childbirth, or the puerperium; antepartum condition) plus 057.0 to indicate parvovirus. Always list the pregnancy code first.

If an IgG-positive gravida was simply exposed to the virus, use the code V23.89 (other high-risk pregnancy) plus V01.7 (contact with or exposure to other viral diseases).

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 best way to code for parvovirus in pregnancy?

A If an IgG-negative gravida who was exposed to the disease seroconverted to IgG positive, assign the code 647.63 (other infectious and parasitic conditions in the mother classifiable elsewhere, but complicating pregnancy, childbirth, or the puerperium; antepartum condition) plus 057.0 to indicate parvovirus. Always list the pregnancy code first.

If an IgG-positive gravida was simply exposed to the virus, use the code V23.89 (other high-risk pregnancy) plus V01.7 (contact with or exposure to other viral diseases).

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 Which CPT code should I use for an omental sling procedure in a patient who was recently diagnosed with cervical cancer?

A I assume that, with the diagnosis of cervical cancer, the omental sling was performed to prevent radiation damage to the small bowel during treatment for the disease. Therefore, report code 44700 (exclusion of small intestine or native tissue, e.g., bladder or omentum, from pelvis by mesh or other prosthesis).

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 Which CPT code should I use for an omental sling procedure in a patient who was recently diagnosed with cervical cancer?

A I assume that, with the diagnosis of cervical cancer, the omental sling was performed to prevent radiation damage to the small bowel during treatment for the disease. Therefore, report code 44700 (exclusion of small intestine or native tissue, e.g., bladder or omentum, from pelvis by mesh or other prosthesis).

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 Which CPT code should I use for an omental sling procedure in a patient who was recently diagnosed with cervical cancer?

A I assume that, with the diagnosis of cervical cancer, the omental sling was performed to prevent radiation damage to the small bowel during treatment for the disease. Therefore, report code 44700 (exclusion of small intestine or native tissue, e.g., bladder or omentum, from pelvis by mesh or other prosthesis).

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 Which code should I report for a computed tomography (CT)-guided drainage of an ovarian cyst via a vaginal approach?

A You actually need to list 2 codes for this procedure. For the drainage of the cyst, report 58800 (vaginal approach). To bill for the CT guidance, report code 76003 (fluoroscopic guidance for needle placement, e.g., biopsy, aspiration, injection; localization device). This code is the best option because it most closely reflects the type of guidance used. (Fluoroscopic CT guidance is rapidly becoming the procedure of choice because it provides the physician with a continuous image of the needle’s position, whereas conventional CT guidance takes 1 picture at a time.)

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 Which code should I report for a computed tomography (CT)-guided drainage of an ovarian cyst via a vaginal approach?

A You actually need to list 2 codes for this procedure. For the drainage of the cyst, report 58800 (vaginal approach). To bill for the CT guidance, report code 76003 (fluoroscopic guidance for needle placement, e.g., biopsy, aspiration, injection; localization device). This code is the best option because it most closely reflects the type of guidance used. (Fluoroscopic CT guidance is rapidly becoming the procedure of choice because it provides the physician with a continuous image of the needle’s position, whereas conventional CT guidance takes 1 picture at a time.)

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 Which code should I report for a computed tomography (CT)-guided drainage of an ovarian cyst via a vaginal approach?

A You actually need to list 2 codes for this procedure. For the drainage of the cyst, report 58800 (vaginal approach). To bill for the CT guidance, report code 76003 (fluoroscopic guidance for needle placement, e.g., biopsy, aspiration, injection; localization device). This code is the best option because it most closely reflects the type of guidance used. (Fluoroscopic CT guidance is rapidly becoming the procedure of choice because it provides the physician with a continuous image of the needle’s position, whereas conventional CT guidance takes 1 picture at a time.)

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 I recently discovered that a nearby practice is using both the 1995 and 1997 Medicare guidelines for coding. However, it is my understanding that you have to choose one set or the other and use it exclusively. Our office uses the 1995 guidelines, and our audit form reflects that decision. Which strategy is correct?

A Both approaches are correct. According to Medicare, you are free to use either set of guidelines or take advantage of both. For example, you may change sets from one patient to the next. If you are audited by Medicare, the auditor will select the set that gives your practice the advantage and will not ask which set you utilized.

This rule was never officially included in the Medicare regulations. However, it was communicated to the former AMA president Percy Wooten, MD, by Nancy-Ann Min DeParle of the Health Care Financing Administration (HCFA). In April, 1998, she said: “I am directing carriers to continue to use both the 1995 and 1997 guidelines, whichever is more advantageous to the physician, until the revisions [to the guidelines] have been completed and there has been an adequate period of time for testing and education.”

Feel free to continue using only the 1995 guidelines. Actually the only difference between the 2 sets is the physical examination criteria.

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 I recently discovered that a nearby practice is using both the 1995 and 1997 Medicare guidelines for coding. However, it is my understanding that you have to choose one set or the other and use it exclusively. Our office uses the 1995 guidelines, and our audit form reflects that decision. Which strategy is correct?

A Both approaches are correct. According to Medicare, you are free to use either set of guidelines or take advantage of both. For example, you may change sets from one patient to the next. If you are audited by Medicare, the auditor will select the set that gives your practice the advantage and will not ask which set you utilized.

This rule was never officially included in the Medicare regulations. However, it was communicated to the former AMA president Percy Wooten, MD, by Nancy-Ann Min DeParle of the Health Care Financing Administration (HCFA). In April, 1998, she said: “I am directing carriers to continue to use both the 1995 and 1997 guidelines, whichever is more advantageous to the physician, until the revisions [to the guidelines] have been completed and there has been an adequate period of time for testing and education.”

Feel free to continue using only the 1995 guidelines. Actually the only difference between the 2 sets is the physical examination criteria.

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 I recently discovered that a nearby practice is using both the 1995 and 1997 Medicare guidelines for coding. However, it is my understanding that you have to choose one set or the other and use it exclusively. Our office uses the 1995 guidelines, and our audit form reflects that decision. Which strategy is correct?

A Both approaches are correct. According to Medicare, you are free to use either set of guidelines or take advantage of both. For example, you may change sets from one patient to the next. If you are audited by Medicare, the auditor will select the set that gives your practice the advantage and will not ask which set you utilized.

This rule was never officially included in the Medicare regulations. However, it was communicated to the former AMA president Percy Wooten, MD, by Nancy-Ann Min DeParle of the Health Care Financing Administration (HCFA). In April, 1998, she said: “I am directing carriers to continue to use both the 1995 and 1997 guidelines, whichever is more advantageous to the physician, until the revisions [to the guidelines] have been completed and there has been an adequate period of time for testing and education.”

Feel free to continue using only the 1995 guidelines. Actually the only difference between the 2 sets is the physical examination criteria.

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.