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REIMBURSEMENT ADVISER
- Patient is a virgin, takes no hormones, and refuses a pelvic exam and Pap smear. Blood pressure is in the normal range. Body mass index is 21. She reports no problems and has no questions.
- Examination of breasts reveals normal skin and nipples, no masses or tenderness, and no lymph-node swelling.
- Patient is given a slip for a routine mammogram and instructions on performing breast self-exam, and is instructed to return in 1 year, barring problems or concerns.
If you report this visit as a problem E/M service using only this diagnosis, on the other hand, you are more than likely to be denied by Medicare.
For Medicare to consider this a covered service billed as a problem E/M service, you would also have to list diagnostic codes that indicate a complaint, a history of a breast condition, or a strong family history of breast cancer. Medicare will pay for the screening mammogram, but the screening breast exam by itself may not be considered a covered service.
You have a few options:
- Contact the Medicare carrier and explain the situation. See if they propose a coding solution that they will accept. Get their answer in writing!
- Bill Medicare using a low-level E/M code (eg, 99212, problem focused exam with straightforward medical decision making) linked to the diagnosis code V76.19. If you choose this option, have the patient sign a waiver that she is responsible for payment should Medicare deny the service. Add the modifier –GA (waiver of liability statement on file) to the problem E/M code. This will allow you to collect payment from the patient.
- Submit the unlisted code or preventive services 99429 because you performed an exam—although not one that meets the criteria of age-specific preventive codes. This code is never reimbursed by Medicare, but once you get a denial, you either can collect from the patient or are able to submit the charge to any secondary insurance she might have. A modifier –GY (item or service statutorily excluded or does not meet the definition of any Medicare benefit) would also need to be added to the preventive medicine code.
Fern testing: CLIA-waived but payer might not cover
Code 87210, in addition to requiring addition of saline or potassium chloride, is not a CLIA-waived test. You would not be able to bill for it unless you have an advanced lab certificate.
Code 89060 is assigned when looking for crystals in synovial fluid. It is also not a CLIA-waived or physician-performed microscopy test, so billing using this code would require an advanced lab certificate as well.
The advent of the national code set has meant that your payers are required to recognize all codes, although they can determine whether to cover a service or not. It may be that this test isn’t covered by your payer, rather than the code not being recognized as correct.
Two voiding studies: Bill together but specify parts
The “9” indicator used by Medicare for bundled codes means that the edit was deleted. In this case, it was deleted on the same date it was added. For some reason, Medicare elects not to remove deleted code pairs from the master database. Although you will get paid for both of these codes, the code order is different depending on whether you are using your own equipment (because of differences in relative value units).
If you bill each test with a modifier -26 (professional component only), you do not own the equipment and the place of service is a facility. In that case, list 51797-26 first and 51795-26-51 second. The modifier -51 is used on the second code because this is a multiple procedure. If you are billing both professional and technical components (ie, you are using your equipment, in the office), billing order is reversed: List 51797 first and 51795-51 second. Do not use a modifier -59 with this code combination.
Fetal genetic abnormality inferred from US; code for further study
At the time of the sonogram, therefore, you can only suspect a problem with the fetal genes; further testing is required. In that case, report 655.13 (known or suspected chromosomal abnormality of the fetus affecting management of mother; antepartum condition or complication) with a secondary diagnosis of 793.99 (other nonspecific abnormal findings on radiological and other examinations of body structure).
Positive ANA—don’t leap to “autoimmune disorder”
Because you have not eliminated the other possibilities for the positive ANA, it is premature to assign the code for an autoimmune condition. Instead, report 648.93 as your primary code (Other current conditions in the mother classifiable elsewhere, complicating pregnancy, childbirth, or the puerperium; antepartum condition or complication), with the secondary diagnosis code 795.79 (Other and unspecified nonspecific immunological findings).
Coding Zoladex depends on the patient’s condition
The drug is supplied as tiny pellets, which are injected under the skin of the abdomen using a small, “trocar-like” needle and syringe. The procedure constitutes an injection. If you are treating breast cancer with this drug, the correct code would be 96402 (Chemotherapy administration, subcutaneous or intramuscular; hormonal antineoplastic). The code for the pellets is J9202 (Goserelin acetate implant, per 3.6 mg). If you administer more than 3.6 mg at a time, remember to adjust the quantity you bill for. If you are using this drug to treat endometriosis or fibroids, CPT directs you to report 90772 for the injection because it is then considered a nonantineoplastic hormone injection.
Call a contraceptive a contraceptive when coding
Implanon’s manufacturer thinks the correct code is 11981 (Insertion, nonbiodegradable drug delivery implant), but I disagree: This is a contraceptive that is implanted under the skin and, under CPT rules, you must use the code that most closely describes the procedure.
Note also that, although Implanon involves insertion of one rod (other systems require insertion of several), the code 11981 has greater relative value units than 11975. This payment difference will not be lost on most payers because the diagnostic link for the procedure, whichever code is reported, is V25.5 (insertion of implantable subdermal contraceptive).
- Patient is a virgin, takes no hormones, and refuses a pelvic exam and Pap smear. Blood pressure is in the normal range. Body mass index is 21. She reports no problems and has no questions.
- Examination of breasts reveals normal skin and nipples, no masses or tenderness, and no lymph-node swelling.
- Patient is given a slip for a routine mammogram and instructions on performing breast self-exam, and is instructed to return in 1 year, barring problems or concerns.
If you report this visit as a problem E/M service using only this diagnosis, on the other hand, you are more than likely to be denied by Medicare.
For Medicare to consider this a covered service billed as a problem E/M service, you would also have to list diagnostic codes that indicate a complaint, a history of a breast condition, or a strong family history of breast cancer. Medicare will pay for the screening mammogram, but the screening breast exam by itself may not be considered a covered service.
You have a few options:
- Contact the Medicare carrier and explain the situation. See if they propose a coding solution that they will accept. Get their answer in writing!
- Bill Medicare using a low-level E/M code (eg, 99212, problem focused exam with straightforward medical decision making) linked to the diagnosis code V76.19. If you choose this option, have the patient sign a waiver that she is responsible for payment should Medicare deny the service. Add the modifier –GA (waiver of liability statement on file) to the problem E/M code. This will allow you to collect payment from the patient.
- Submit the unlisted code or preventive services 99429 because you performed an exam—although not one that meets the criteria of age-specific preventive codes. This code is never reimbursed by Medicare, but once you get a denial, you either can collect from the patient or are able to submit the charge to any secondary insurance she might have. A modifier –GY (item or service statutorily excluded or does not meet the definition of any Medicare benefit) would also need to be added to the preventive medicine code.
Fern testing: CLIA-waived but payer might not cover
Code 87210, in addition to requiring addition of saline or potassium chloride, is not a CLIA-waived test. You would not be able to bill for it unless you have an advanced lab certificate.
Code 89060 is assigned when looking for crystals in synovial fluid. It is also not a CLIA-waived or physician-performed microscopy test, so billing using this code would require an advanced lab certificate as well.
The advent of the national code set has meant that your payers are required to recognize all codes, although they can determine whether to cover a service or not. It may be that this test isn’t covered by your payer, rather than the code not being recognized as correct.
Two voiding studies: Bill together but specify parts
The “9” indicator used by Medicare for bundled codes means that the edit was deleted. In this case, it was deleted on the same date it was added. For some reason, Medicare elects not to remove deleted code pairs from the master database. Although you will get paid for both of these codes, the code order is different depending on whether you are using your own equipment (because of differences in relative value units).
If you bill each test with a modifier -26 (professional component only), you do not own the equipment and the place of service is a facility. In that case, list 51797-26 first and 51795-26-51 second. The modifier -51 is used on the second code because this is a multiple procedure. If you are billing both professional and technical components (ie, you are using your equipment, in the office), billing order is reversed: List 51797 first and 51795-51 second. Do not use a modifier -59 with this code combination.
Fetal genetic abnormality inferred from US; code for further study
At the time of the sonogram, therefore, you can only suspect a problem with the fetal genes; further testing is required. In that case, report 655.13 (known or suspected chromosomal abnormality of the fetus affecting management of mother; antepartum condition or complication) with a secondary diagnosis of 793.99 (other nonspecific abnormal findings on radiological and other examinations of body structure).
Positive ANA—don’t leap to “autoimmune disorder”
Because you have not eliminated the other possibilities for the positive ANA, it is premature to assign the code for an autoimmune condition. Instead, report 648.93 as your primary code (Other current conditions in the mother classifiable elsewhere, complicating pregnancy, childbirth, or the puerperium; antepartum condition or complication), with the secondary diagnosis code 795.79 (Other and unspecified nonspecific immunological findings).
Coding Zoladex depends on the patient’s condition
The drug is supplied as tiny pellets, which are injected under the skin of the abdomen using a small, “trocar-like” needle and syringe. The procedure constitutes an injection. If you are treating breast cancer with this drug, the correct code would be 96402 (Chemotherapy administration, subcutaneous or intramuscular; hormonal antineoplastic). The code for the pellets is J9202 (Goserelin acetate implant, per 3.6 mg). If you administer more than 3.6 mg at a time, remember to adjust the quantity you bill for. If you are using this drug to treat endometriosis or fibroids, CPT directs you to report 90772 for the injection because it is then considered a nonantineoplastic hormone injection.
Call a contraceptive a contraceptive when coding
Implanon’s manufacturer thinks the correct code is 11981 (Insertion, nonbiodegradable drug delivery implant), but I disagree: This is a contraceptive that is implanted under the skin and, under CPT rules, you must use the code that most closely describes the procedure.
Note also that, although Implanon involves insertion of one rod (other systems require insertion of several), the code 11981 has greater relative value units than 11975. This payment difference will not be lost on most payers because the diagnostic link for the procedure, whichever code is reported, is V25.5 (insertion of implantable subdermal contraceptive).
- Patient is a virgin, takes no hormones, and refuses a pelvic exam and Pap smear. Blood pressure is in the normal range. Body mass index is 21. She reports no problems and has no questions.
- Examination of breasts reveals normal skin and nipples, no masses or tenderness, and no lymph-node swelling.
- Patient is given a slip for a routine mammogram and instructions on performing breast self-exam, and is instructed to return in 1 year, barring problems or concerns.
If you report this visit as a problem E/M service using only this diagnosis, on the other hand, you are more than likely to be denied by Medicare.
For Medicare to consider this a covered service billed as a problem E/M service, you would also have to list diagnostic codes that indicate a complaint, a history of a breast condition, or a strong family history of breast cancer. Medicare will pay for the screening mammogram, but the screening breast exam by itself may not be considered a covered service.
You have a few options:
- Contact the Medicare carrier and explain the situation. See if they propose a coding solution that they will accept. Get their answer in writing!
- Bill Medicare using a low-level E/M code (eg, 99212, problem focused exam with straightforward medical decision making) linked to the diagnosis code V76.19. If you choose this option, have the patient sign a waiver that she is responsible for payment should Medicare deny the service. Add the modifier –GA (waiver of liability statement on file) to the problem E/M code. This will allow you to collect payment from the patient.
- Submit the unlisted code or preventive services 99429 because you performed an exam—although not one that meets the criteria of age-specific preventive codes. This code is never reimbursed by Medicare, but once you get a denial, you either can collect from the patient or are able to submit the charge to any secondary insurance she might have. A modifier –GY (item or service statutorily excluded or does not meet the definition of any Medicare benefit) would also need to be added to the preventive medicine code.
Fern testing: CLIA-waived but payer might not cover
Code 87210, in addition to requiring addition of saline or potassium chloride, is not a CLIA-waived test. You would not be able to bill for it unless you have an advanced lab certificate.
Code 89060 is assigned when looking for crystals in synovial fluid. It is also not a CLIA-waived or physician-performed microscopy test, so billing using this code would require an advanced lab certificate as well.
The advent of the national code set has meant that your payers are required to recognize all codes, although they can determine whether to cover a service or not. It may be that this test isn’t covered by your payer, rather than the code not being recognized as correct.
Two voiding studies: Bill together but specify parts
The “9” indicator used by Medicare for bundled codes means that the edit was deleted. In this case, it was deleted on the same date it was added. For some reason, Medicare elects not to remove deleted code pairs from the master database. Although you will get paid for both of these codes, the code order is different depending on whether you are using your own equipment (because of differences in relative value units).
If you bill each test with a modifier -26 (professional component only), you do not own the equipment and the place of service is a facility. In that case, list 51797-26 first and 51795-26-51 second. The modifier -51 is used on the second code because this is a multiple procedure. If you are billing both professional and technical components (ie, you are using your equipment, in the office), billing order is reversed: List 51797 first and 51795-51 second. Do not use a modifier -59 with this code combination.
Fetal genetic abnormality inferred from US; code for further study
At the time of the sonogram, therefore, you can only suspect a problem with the fetal genes; further testing is required. In that case, report 655.13 (known or suspected chromosomal abnormality of the fetus affecting management of mother; antepartum condition or complication) with a secondary diagnosis of 793.99 (other nonspecific abnormal findings on radiological and other examinations of body structure).
Positive ANA—don’t leap to “autoimmune disorder”
Because you have not eliminated the other possibilities for the positive ANA, it is premature to assign the code for an autoimmune condition. Instead, report 648.93 as your primary code (Other current conditions in the mother classifiable elsewhere, complicating pregnancy, childbirth, or the puerperium; antepartum condition or complication), with the secondary diagnosis code 795.79 (Other and unspecified nonspecific immunological findings).
Coding Zoladex depends on the patient’s condition
The drug is supplied as tiny pellets, which are injected under the skin of the abdomen using a small, “trocar-like” needle and syringe. The procedure constitutes an injection. If you are treating breast cancer with this drug, the correct code would be 96402 (Chemotherapy administration, subcutaneous or intramuscular; hormonal antineoplastic). The code for the pellets is J9202 (Goserelin acetate implant, per 3.6 mg). If you administer more than 3.6 mg at a time, remember to adjust the quantity you bill for. If you are using this drug to treat endometriosis or fibroids, CPT directs you to report 90772 for the injection because it is then considered a nonantineoplastic hormone injection.
Call a contraceptive a contraceptive when coding
Implanon’s manufacturer thinks the correct code is 11981 (Insertion, nonbiodegradable drug delivery implant), but I disagree: This is a contraceptive that is implanted under the skin and, under CPT rules, you must use the code that most closely describes the procedure.
Note also that, although Implanon involves insertion of one rod (other systems require insertion of several), the code 11981 has greater relative value units than 11975. This payment difference will not be lost on most payers because the diagnostic link for the procedure, whichever code is reported, is V25.5 (insertion of implantable subdermal contraceptive).
Reimbursement Adviser on the Web
Is injectable contraceptive “medical necessity”?
The insurance company told the patient that it would pay the claim if we used a different diagnosis code. What code should we assign to indicate that Depo-Provera is medically indicated?
The real problem here, however, may be that the patient’s insurance policy does not cover contraception. If that’s the case, route of administration won’t affect coverage and she is responsible for paying for injections.
Advise the patient to contact the insurer to resolve the matter of coverage. If the company confirms that contraception is covered but insists that you use a different diagnosis code, try V25.8, as I recommended. Or have the patient ask the insurer to state—in writing—what the correct code is so that you can submit the claim according to their rules.
Retained cerclage suture just part of E/M service
There is no code for removing the remnant of cerclage suture. In fact, if it was removed without anesthesia by a physician who did not place the cerclage suture, it is just part of an E/M service. If you are providing postpartum care, I assume that you or a member of your group placed the cerclage suture; removal is therefore not billable separately.
Vaginal gush of fluid: How do you select a code?
- Vaginal discharge: 623.5 (Leukorrhea, not specified as infective), with V22.2 (Pregnant state, incidental). Because the patient is pregnant, this option would require that you have documented that the condition is either incidental to the pregnancy or not affecting management of the mother, the pregnancy, or the fetus.
- Other specified complications of pregnancy (646.83)
- Other specified indications for care or intervention related to labor and delivery (659.8X)
- No leakage or evidence of fluid was found: V65.5 (Feared condition not demonstrated) with V22.2 (Pregnant state, incidental).
Get reimbursed for counseling absent patient?
If the patient’s treatment for an illness or condition is being discussed, you can report a problem E/M service. Otherwise, this is a preventive counseling service reported by time using 99401–99404 (Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]).
Remember to caution the mother that the visit may not be covered, making her responsible for the bill.
Is injectable contraceptive “medical necessity”?
The insurance company told the patient that it would pay the claim if we used a different diagnosis code. What code should we assign to indicate that Depo-Provera is medically indicated?
The real problem here, however, may be that the patient’s insurance policy does not cover contraception. If that’s the case, route of administration won’t affect coverage and she is responsible for paying for injections.
Advise the patient to contact the insurer to resolve the matter of coverage. If the company confirms that contraception is covered but insists that you use a different diagnosis code, try V25.8, as I recommended. Or have the patient ask the insurer to state—in writing—what the correct code is so that you can submit the claim according to their rules.
Retained cerclage suture just part of E/M service
There is no code for removing the remnant of cerclage suture. In fact, if it was removed without anesthesia by a physician who did not place the cerclage suture, it is just part of an E/M service. If you are providing postpartum care, I assume that you or a member of your group placed the cerclage suture; removal is therefore not billable separately.
Vaginal gush of fluid: How do you select a code?
- Vaginal discharge: 623.5 (Leukorrhea, not specified as infective), with V22.2 (Pregnant state, incidental). Because the patient is pregnant, this option would require that you have documented that the condition is either incidental to the pregnancy or not affecting management of the mother, the pregnancy, or the fetus.
- Other specified complications of pregnancy (646.83)
- Other specified indications for care or intervention related to labor and delivery (659.8X)
- No leakage or evidence of fluid was found: V65.5 (Feared condition not demonstrated) with V22.2 (Pregnant state, incidental).
Get reimbursed for counseling absent patient?
If the patient’s treatment for an illness or condition is being discussed, you can report a problem E/M service. Otherwise, this is a preventive counseling service reported by time using 99401–99404 (Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]).
Remember to caution the mother that the visit may not be covered, making her responsible for the bill.
Is injectable contraceptive “medical necessity”?
The insurance company told the patient that it would pay the claim if we used a different diagnosis code. What code should we assign to indicate that Depo-Provera is medically indicated?
The real problem here, however, may be that the patient’s insurance policy does not cover contraception. If that’s the case, route of administration won’t affect coverage and she is responsible for paying for injections.
Advise the patient to contact the insurer to resolve the matter of coverage. If the company confirms that contraception is covered but insists that you use a different diagnosis code, try V25.8, as I recommended. Or have the patient ask the insurer to state—in writing—what the correct code is so that you can submit the claim according to their rules.
Retained cerclage suture just part of E/M service
There is no code for removing the remnant of cerclage suture. In fact, if it was removed without anesthesia by a physician who did not place the cerclage suture, it is just part of an E/M service. If you are providing postpartum care, I assume that you or a member of your group placed the cerclage suture; removal is therefore not billable separately.
Vaginal gush of fluid: How do you select a code?
- Vaginal discharge: 623.5 (Leukorrhea, not specified as infective), with V22.2 (Pregnant state, incidental). Because the patient is pregnant, this option would require that you have documented that the condition is either incidental to the pregnancy or not affecting management of the mother, the pregnancy, or the fetus.
- Other specified complications of pregnancy (646.83)
- Other specified indications for care or intervention related to labor and delivery (659.8X)
- No leakage or evidence of fluid was found: V65.5 (Feared condition not demonstrated) with V22.2 (Pregnant state, incidental).
Get reimbursed for counseling absent patient?
If the patient’s treatment for an illness or condition is being discussed, you can report a problem E/M service. Otherwise, this is a preventive counseling service reported by time using 99401–99404 (Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]).
Remember to caution the mother that the visit may not be covered, making her responsible for the bill.
Is it “major” or “minor” dehiscence repair? ... No new code for new Depo-Provera formulation
You have 2 code choices. Surgery to repair wound dehiscence (Diagnosis code 998.32, Disruption of external operation wound) would be reported with:
- code 12020 (Treatment of superficial wound dehiscence; simple closure), which has a global period of 10 days, or
- code 13160 (Secondary closure of surgical wound or dehiscence; extensive or complicated), which has a 90-day global period.
If, instead, dehiscence involved complex repair and you documented significant evaluation above and beyond normal postoperative care before determining that repair was necessary, you may bill that level of service with a modifier -57.
No new code for new Depo-Provera formulation
- Report J3490 (Unclassified drug), but also submit the National Drug Code (NDC) number to identify the injection
- Report 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]) and be sure to indicate the NDC number
- Report the existing code for a noncontraceptive dosage of Depo-Provera (J1051) multiplied by a quantity of 2 (J1051 is for a 50-mg dosage).
You have 2 code choices. Surgery to repair wound dehiscence (Diagnosis code 998.32, Disruption of external operation wound) would be reported with:
- code 12020 (Treatment of superficial wound dehiscence; simple closure), which has a global period of 10 days, or
- code 13160 (Secondary closure of surgical wound or dehiscence; extensive or complicated), which has a 90-day global period.
If, instead, dehiscence involved complex repair and you documented significant evaluation above and beyond normal postoperative care before determining that repair was necessary, you may bill that level of service with a modifier -57.
No new code for new Depo-Provera formulation
- Report J3490 (Unclassified drug), but also submit the National Drug Code (NDC) number to identify the injection
- Report 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]) and be sure to indicate the NDC number
- Report the existing code for a noncontraceptive dosage of Depo-Provera (J1051) multiplied by a quantity of 2 (J1051 is for a 50-mg dosage).
You have 2 code choices. Surgery to repair wound dehiscence (Diagnosis code 998.32, Disruption of external operation wound) would be reported with:
- code 12020 (Treatment of superficial wound dehiscence; simple closure), which has a global period of 10 days, or
- code 13160 (Secondary closure of surgical wound or dehiscence; extensive or complicated), which has a 90-day global period.
If, instead, dehiscence involved complex repair and you documented significant evaluation above and beyond normal postoperative care before determining that repair was necessary, you may bill that level of service with a modifier -57.
No new code for new Depo-Provera formulation
- Report J3490 (Unclassified drug), but also submit the National Drug Code (NDC) number to identify the injection
- Report 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]) and be sure to indicate the NDC number
- Report the existing code for a noncontraceptive dosage of Depo-Provera (J1051) multiplied by a quantity of 2 (J1051 is for a 50-mg dosage).
EXCLUSIVELY ON THE WEBCo-surgery: Both surgeons bill, with modifier ... Delay doesn't change coding for surgical tx of incomplete abortion
Co-surgery: Both surgeons bill, with modifier ... Delay doesn't change coding for surgical tx of incomplete abortion
The general surgeon should also bill for the surgical assistant services of the PA by adding a modifier AS [Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery] to this same surgical code. Some payers might deny an assistant in a co-surgery case, but the documentation in this situation would support the need because the PA assisted only when you were not present.
Delay doesn’t change coding for surgical tx of incomplete abortion
The diagnosis for bleeding after an abortion performed at a previous surgery is 639.1.
The general surgeon should also bill for the surgical assistant services of the PA by adding a modifier AS [Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery] to this same surgical code. Some payers might deny an assistant in a co-surgery case, but the documentation in this situation would support the need because the PA assisted only when you were not present.
Delay doesn’t change coding for surgical tx of incomplete abortion
The diagnosis for bleeding after an abortion performed at a previous surgery is 639.1.
The general surgeon should also bill for the surgical assistant services of the PA by adding a modifier AS [Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery] to this same surgical code. Some payers might deny an assistant in a co-surgery case, but the documentation in this situation would support the need because the PA assisted only when you were not present.
Delay doesn’t change coding for surgical tx of incomplete abortion
The diagnosis for bleeding after an abortion performed at a previous surgery is 639.1.
Co-surgery: Both surgeons bill, with modifier ... Delay doesn't change coding for surgical tx of incomplete abortion
Co-surgery: Both surgeons bill, with modifier ... Delay doesn't change coding for surgical tx of incomplete abortion
Multisite injection might not be reimbursed as multiple procedures ... Split preop visit from surgery? Maybe
What may present a problem, however, is that you are administering lidocaine in several areas of the vulva. Many payers have a unit limitation for the number of injections you can bill at one time; if you use the same syringe and needle for injection at multiple sites, the payer may decide to reimburse for only a single injection.
Some practices have been successful in getting fair reimbursement by billing code 58999 [Unlisted procedure, female genital system (nonobstetrical)] for this treatment.
If you will be billing the injection procedure instead, note that the “J” code for lidocaine was deleted in 2006. To bill for lidocaine, report J3490 [Unclassified drugs]. Lidocaine would be included as a supply with code 58999 and therefore not separately billable.
Split preop visit from surgery? Maybe
Some payers will reimburse for this visit, however, and you owe it to them to indicate the nature of the visit. This means that you should not provide a diagnosis code for the visit that is the actual reason for doing the surgery; instead, code V72.83 [other specified preop exam] or V72.84 [unspecified preop exam]. This allows the payer to apply its policy on this matter. A payer that includes the preop exam will deny the claim; one that doesn’t, will reimburse you.
One surgery, two surgeons: How do both code to be reimbursed? Find the answer and read more “Reimbursement Adviser” on the Web at www.obgmanagement.com
What may present a problem, however, is that you are administering lidocaine in several areas of the vulva. Many payers have a unit limitation for the number of injections you can bill at one time; if you use the same syringe and needle for injection at multiple sites, the payer may decide to reimburse for only a single injection.
Some practices have been successful in getting fair reimbursement by billing code 58999 [Unlisted procedure, female genital system (nonobstetrical)] for this treatment.
If you will be billing the injection procedure instead, note that the “J” code for lidocaine was deleted in 2006. To bill for lidocaine, report J3490 [Unclassified drugs]. Lidocaine would be included as a supply with code 58999 and therefore not separately billable.
Split preop visit from surgery? Maybe
Some payers will reimburse for this visit, however, and you owe it to them to indicate the nature of the visit. This means that you should not provide a diagnosis code for the visit that is the actual reason for doing the surgery; instead, code V72.83 [other specified preop exam] or V72.84 [unspecified preop exam]. This allows the payer to apply its policy on this matter. A payer that includes the preop exam will deny the claim; one that doesn’t, will reimburse you.
One surgery, two surgeons: How do both code to be reimbursed? Find the answer and read more “Reimbursement Adviser” on the Web at www.obgmanagement.com
What may present a problem, however, is that you are administering lidocaine in several areas of the vulva. Many payers have a unit limitation for the number of injections you can bill at one time; if you use the same syringe and needle for injection at multiple sites, the payer may decide to reimburse for only a single injection.
Some practices have been successful in getting fair reimbursement by billing code 58999 [Unlisted procedure, female genital system (nonobstetrical)] for this treatment.
If you will be billing the injection procedure instead, note that the “J” code for lidocaine was deleted in 2006. To bill for lidocaine, report J3490 [Unclassified drugs]. Lidocaine would be included as a supply with code 58999 and therefore not separately billable.
Split preop visit from surgery? Maybe
Some payers will reimburse for this visit, however, and you owe it to them to indicate the nature of the visit. This means that you should not provide a diagnosis code for the visit that is the actual reason for doing the surgery; instead, code V72.83 [other specified preop exam] or V72.84 [unspecified preop exam]. This allows the payer to apply its policy on this matter. A payer that includes the preop exam will deny the claim; one that doesn’t, will reimburse you.
One surgery, two surgeons: How do both code to be reimbursed? Find the answer and read more “Reimbursement Adviser” on the Web at www.obgmanagement.com
Avoid confusion over terms when billing McCall culdoplasty ... Complete and transvaginal US scan must be specified
Your code choices are:
58263 Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele
58270 Vaginal hysterectomy, for uterus 250 g or less; with repair of enterocele
58292 Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s), with repair of enterocele
58294 Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele
Don’t blame your billing staff if this is what occurred. The term “McCall culdoplasty” appears nowhere in the CPT book, so your billers would need to know that you actually performed an enterocele repair.
Correctly communicating what you did is an important step in getting the claim paid in a timely manner. Refile with the correct code!
Read a description of the technique of McCall culdoplasty.
Complete and transvaginal US scan must be specified
Your code choices are:
58263 Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele
58270 Vaginal hysterectomy, for uterus 250 g or less; with repair of enterocele
58292 Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s), with repair of enterocele
58294 Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele
Don’t blame your billing staff if this is what occurred. The term “McCall culdoplasty” appears nowhere in the CPT book, so your billers would need to know that you actually performed an enterocele repair.
Correctly communicating what you did is an important step in getting the claim paid in a timely manner. Refile with the correct code!
Read a description of the technique of McCall culdoplasty.
Complete and transvaginal US scan must be specified
Your code choices are:
58263 Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele
58270 Vaginal hysterectomy, for uterus 250 g or less; with repair of enterocele
58292 Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s), with repair of enterocele
58294 Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele
Don’t blame your billing staff if this is what occurred. The term “McCall culdoplasty” appears nowhere in the CPT book, so your billers would need to know that you actually performed an enterocele repair.
Correctly communicating what you did is an important step in getting the claim paid in a timely manner. Refile with the correct code!
Read a description of the technique of McCall culdoplasty.
Complete and transvaginal US scan must be specified
CPT 2007: What’s in it for you?
ObGyns stand to benefit from new Current Procedural Terminology (CPT) codes that capture more of the specifics of procedures such as laparoscopic hysterectomy, and provide codes for newer kinds of services such as prenatal nuchal translucency screening and genetic counseling. A downside for 2007—getting accustomed to the renumbered codes for bone density and breast imaging.
Laparoscopic hysterectomy codes get specific
58541 Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less
58542 …with removal of tube(s) and/or ovary(s)
58543 Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than
250 g
58544 …with removal of tube(s) and/or ovary(s)
Nuchal translucency: Document the detail
76813 Ultrasound, pregnant uterus, real time with image documentation, 1st-trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or 1st gestation
76814 …each additional gestation
Reimbursement should become routine for 1st-trimester nuchal translucency ultrasound imaging.
Coding has been a challenge; in fact, ACOG only recommended reporting the unlisted code 76999 (unlisted ultrasound procedure [eg, diagnostic, interventional]), which requires submission of documentation to make the case for payment. The test is normally performed between 11 and 13 weeks’ gestation.
When measured correctly, nuchal translucency thickness is a powerful marker in Down syndrome screening in the late first trimester
Even when the payer does not require it, documentation is important. Nuchal translucency ultrasound documentation should include:
- the fetal crown–rump length
- verification of the sagittal view of the fetal spine
- 3 measurements of the maximum thickness of the subcutaneous translucency between the skin and the soft tissue overlying the cervical spine
- as with all ultrasound procedures, image documentation and a final written report
Special training is required by the sonographer or physician who performs this measurement. So be aware that the payer may have rules to ensure such training.
Different codes for initial and recurrent cancer
58950 Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy
Primary malignancy resections will continue to be reported with the existing code numbers 58950 through 58952. To make the point clear, CPT revised the wording of the base code, 58950, to specify the initial operation.
58957 Resection (tumor debulking) of recurrent ovarian, tubal, primary peritoneal, uterine malignancy (intra-abdominal, retroperitoneal tumors), with omentectomy, if performed
58958 …with pelvic lymphadenectomy
Unlike other codes for malignancy in the female genitourinary section of CPT, the above 2 new codes specify a broader range of cancers to include uterine malignancy.
Previously, code 49200 or code 49201 (excision or destruction, open, intra-abdominal or retroperitoneal tumors or cysts or endometriomas) would have been as reported for recurrent uterine malignancy.
Do not report these codes in addition: 38770 and 38780 (removal of pelvic or retroperitoneal lymph nodes), 44005 (enterolysis), 49000 (exploratory laparotomy), 49200–49215 (open excision of tumors), 49255 (omentectomy), or 58900–58960 (removal of tubes and ovaries).
New technologies
Uterine artery embolization
37210 Uterine artery embolization
The new code includes vascular access, vessel selection, injection of the material, intraprocedure mapping, and all radiological supervision and interpretation, including image guidance.
Genetic counseling
96040 Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/family
This code is good news for practices that use the services of a genetic counselor. Need, content, and total time must be documented in the report. However, Medicare has assigned no physician relative value units to this new code because they consider it bundled into any E/M service. Check with your payers about separate reimbursement for this service.
| OLD | NEW | |
| BONE DENSITY | ||
| CT, bone mineral density study 1 or more sites | ||
| Axial skeleton (eg, hips, pelvis, spine) | 76060 | 77078 |
| Appendicular skeleton (peripheral) (eg, radius, wrist, heel) | 76061 | 77079 |
| Dual-energy X-ray absorptiometry, bone-density study 1 or more sites | ||
| Axial skeleton | 76065 | 77080 |
| Appendicular skeleton | 76067 | 77081 |
| Vertebral fracture assessment | 76077 | 77082 |
| Radiographic absorptiometry (eg, photodensitometry, radiogrammetry) 1 or more sites | 76078 | 77083 |
| MAMMOGRAPHY | ||
| Unilateral | 76090 | 77055 |
| Bilateral | 76091 | 77056 |
| Screening mammography, bilateral (2-view film study of each breast) | 76092 | 77057 |
| INTRAOPERATIVE ULTRASOUND | ||
| Ultrasound guidance, intraoperative | 76986 | 76998 |
Elizabeth W. Woodcock
Atlanta-based Elizabeth W. Woodcock is a speaker, trainer, and author specializing in practice management. Among her recent books is Mastering Patient Flow.
It’s likely you counsel your patients about smoking cessation at least once a day, if not more. Do you know that you can be reimbursed for this important service? Medicare and Medicaid pay for 8 visits annually in a 12-month period, and other payers are rapidly following suit. In 2005, the Centers for Medicare and Medicaid Services (CMS) added procedure codes for intermediate and intensive smoking cessation visits:
G0375 Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes.
Short descriptor Smoke/tobacco counseling 3-10
G0376 Smoking and tobacco-use cessation visit; intensive, greater than 10 minutes.
Short descriptor Smoke/tobacco counseling greater than 10
G0375 pays approximately $13; G0376 pays approximately $25. The exact payment depends on your geographic practice cost index (GPCI) as determined by CMS.
These codes do not modify coverage for minimal smoking cessation counseling (3 minutes or less in duration), which is considered covered as part of each evaluation and management (E/M) visit, and therefore is not separately billable.
ObGyns stand to benefit from new Current Procedural Terminology (CPT) codes that capture more of the specifics of procedures such as laparoscopic hysterectomy, and provide codes for newer kinds of services such as prenatal nuchal translucency screening and genetic counseling. A downside for 2007—getting accustomed to the renumbered codes for bone density and breast imaging.
Laparoscopic hysterectomy codes get specific
58541 Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less
58542 …with removal of tube(s) and/or ovary(s)
58543 Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than
250 g
58544 …with removal of tube(s) and/or ovary(s)
Nuchal translucency: Document the detail
76813 Ultrasound, pregnant uterus, real time with image documentation, 1st-trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or 1st gestation
76814 …each additional gestation
Reimbursement should become routine for 1st-trimester nuchal translucency ultrasound imaging.
Coding has been a challenge; in fact, ACOG only recommended reporting the unlisted code 76999 (unlisted ultrasound procedure [eg, diagnostic, interventional]), which requires submission of documentation to make the case for payment. The test is normally performed between 11 and 13 weeks’ gestation.
When measured correctly, nuchal translucency thickness is a powerful marker in Down syndrome screening in the late first trimester
Even when the payer does not require it, documentation is important. Nuchal translucency ultrasound documentation should include:
- the fetal crown–rump length
- verification of the sagittal view of the fetal spine
- 3 measurements of the maximum thickness of the subcutaneous translucency between the skin and the soft tissue overlying the cervical spine
- as with all ultrasound procedures, image documentation and a final written report
Special training is required by the sonographer or physician who performs this measurement. So be aware that the payer may have rules to ensure such training.
Different codes for initial and recurrent cancer
58950 Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy
Primary malignancy resections will continue to be reported with the existing code numbers 58950 through 58952. To make the point clear, CPT revised the wording of the base code, 58950, to specify the initial operation.
58957 Resection (tumor debulking) of recurrent ovarian, tubal, primary peritoneal, uterine malignancy (intra-abdominal, retroperitoneal tumors), with omentectomy, if performed
58958 …with pelvic lymphadenectomy
Unlike other codes for malignancy in the female genitourinary section of CPT, the above 2 new codes specify a broader range of cancers to include uterine malignancy.
Previously, code 49200 or code 49201 (excision or destruction, open, intra-abdominal or retroperitoneal tumors or cysts or endometriomas) would have been as reported for recurrent uterine malignancy.
Do not report these codes in addition: 38770 and 38780 (removal of pelvic or retroperitoneal lymph nodes), 44005 (enterolysis), 49000 (exploratory laparotomy), 49200–49215 (open excision of tumors), 49255 (omentectomy), or 58900–58960 (removal of tubes and ovaries).
New technologies
Uterine artery embolization
37210 Uterine artery embolization
The new code includes vascular access, vessel selection, injection of the material, intraprocedure mapping, and all radiological supervision and interpretation, including image guidance.
Genetic counseling
96040 Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/family
This code is good news for practices that use the services of a genetic counselor. Need, content, and total time must be documented in the report. However, Medicare has assigned no physician relative value units to this new code because they consider it bundled into any E/M service. Check with your payers about separate reimbursement for this service.
| OLD | NEW | |
| BONE DENSITY | ||
| CT, bone mineral density study 1 or more sites | ||
| Axial skeleton (eg, hips, pelvis, spine) | 76060 | 77078 |
| Appendicular skeleton (peripheral) (eg, radius, wrist, heel) | 76061 | 77079 |
| Dual-energy X-ray absorptiometry, bone-density study 1 or more sites | ||
| Axial skeleton | 76065 | 77080 |
| Appendicular skeleton | 76067 | 77081 |
| Vertebral fracture assessment | 76077 | 77082 |
| Radiographic absorptiometry (eg, photodensitometry, radiogrammetry) 1 or more sites | 76078 | 77083 |
| MAMMOGRAPHY | ||
| Unilateral | 76090 | 77055 |
| Bilateral | 76091 | 77056 |
| Screening mammography, bilateral (2-view film study of each breast) | 76092 | 77057 |
| INTRAOPERATIVE ULTRASOUND | ||
| Ultrasound guidance, intraoperative | 76986 | 76998 |
Elizabeth W. Woodcock
Atlanta-based Elizabeth W. Woodcock is a speaker, trainer, and author specializing in practice management. Among her recent books is Mastering Patient Flow.
It’s likely you counsel your patients about smoking cessation at least once a day, if not more. Do you know that you can be reimbursed for this important service? Medicare and Medicaid pay for 8 visits annually in a 12-month period, and other payers are rapidly following suit. In 2005, the Centers for Medicare and Medicaid Services (CMS) added procedure codes for intermediate and intensive smoking cessation visits:
G0375 Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes.
Short descriptor Smoke/tobacco counseling 3-10
G0376 Smoking and tobacco-use cessation visit; intensive, greater than 10 minutes.
Short descriptor Smoke/tobacco counseling greater than 10
G0375 pays approximately $13; G0376 pays approximately $25. The exact payment depends on your geographic practice cost index (GPCI) as determined by CMS.
These codes do not modify coverage for minimal smoking cessation counseling (3 minutes or less in duration), which is considered covered as part of each evaluation and management (E/M) visit, and therefore is not separately billable.
ObGyns stand to benefit from new Current Procedural Terminology (CPT) codes that capture more of the specifics of procedures such as laparoscopic hysterectomy, and provide codes for newer kinds of services such as prenatal nuchal translucency screening and genetic counseling. A downside for 2007—getting accustomed to the renumbered codes for bone density and breast imaging.
Laparoscopic hysterectomy codes get specific
58541 Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less
58542 …with removal of tube(s) and/or ovary(s)
58543 Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than
250 g
58544 …with removal of tube(s) and/or ovary(s)
Nuchal translucency: Document the detail
76813 Ultrasound, pregnant uterus, real time with image documentation, 1st-trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or 1st gestation
76814 …each additional gestation
Reimbursement should become routine for 1st-trimester nuchal translucency ultrasound imaging.
Coding has been a challenge; in fact, ACOG only recommended reporting the unlisted code 76999 (unlisted ultrasound procedure [eg, diagnostic, interventional]), which requires submission of documentation to make the case for payment. The test is normally performed between 11 and 13 weeks’ gestation.
When measured correctly, nuchal translucency thickness is a powerful marker in Down syndrome screening in the late first trimester
Even when the payer does not require it, documentation is important. Nuchal translucency ultrasound documentation should include:
- the fetal crown–rump length
- verification of the sagittal view of the fetal spine
- 3 measurements of the maximum thickness of the subcutaneous translucency between the skin and the soft tissue overlying the cervical spine
- as with all ultrasound procedures, image documentation and a final written report
Special training is required by the sonographer or physician who performs this measurement. So be aware that the payer may have rules to ensure such training.
Different codes for initial and recurrent cancer
58950 Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy
Primary malignancy resections will continue to be reported with the existing code numbers 58950 through 58952. To make the point clear, CPT revised the wording of the base code, 58950, to specify the initial operation.
58957 Resection (tumor debulking) of recurrent ovarian, tubal, primary peritoneal, uterine malignancy (intra-abdominal, retroperitoneal tumors), with omentectomy, if performed
58958 …with pelvic lymphadenectomy
Unlike other codes for malignancy in the female genitourinary section of CPT, the above 2 new codes specify a broader range of cancers to include uterine malignancy.
Previously, code 49200 or code 49201 (excision or destruction, open, intra-abdominal or retroperitoneal tumors or cysts or endometriomas) would have been as reported for recurrent uterine malignancy.
Do not report these codes in addition: 38770 and 38780 (removal of pelvic or retroperitoneal lymph nodes), 44005 (enterolysis), 49000 (exploratory laparotomy), 49200–49215 (open excision of tumors), 49255 (omentectomy), or 58900–58960 (removal of tubes and ovaries).
New technologies
Uterine artery embolization
37210 Uterine artery embolization
The new code includes vascular access, vessel selection, injection of the material, intraprocedure mapping, and all radiological supervision and interpretation, including image guidance.
Genetic counseling
96040 Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/family
This code is good news for practices that use the services of a genetic counselor. Need, content, and total time must be documented in the report. However, Medicare has assigned no physician relative value units to this new code because they consider it bundled into any E/M service. Check with your payers about separate reimbursement for this service.
| OLD | NEW | |
| BONE DENSITY | ||
| CT, bone mineral density study 1 or more sites | ||
| Axial skeleton (eg, hips, pelvis, spine) | 76060 | 77078 |
| Appendicular skeleton (peripheral) (eg, radius, wrist, heel) | 76061 | 77079 |
| Dual-energy X-ray absorptiometry, bone-density study 1 or more sites | ||
| Axial skeleton | 76065 | 77080 |
| Appendicular skeleton | 76067 | 77081 |
| Vertebral fracture assessment | 76077 | 77082 |
| Radiographic absorptiometry (eg, photodensitometry, radiogrammetry) 1 or more sites | 76078 | 77083 |
| MAMMOGRAPHY | ||
| Unilateral | 76090 | 77055 |
| Bilateral | 76091 | 77056 |
| Screening mammography, bilateral (2-view film study of each breast) | 76092 | 77057 |
| INTRAOPERATIVE ULTRASOUND | ||
| Ultrasound guidance, intraoperative | 76986 | 76998 |
Elizabeth W. Woodcock
Atlanta-based Elizabeth W. Woodcock is a speaker, trainer, and author specializing in practice management. Among her recent books is Mastering Patient Flow.
It’s likely you counsel your patients about smoking cessation at least once a day, if not more. Do you know that you can be reimbursed for this important service? Medicare and Medicaid pay for 8 visits annually in a 12-month period, and other payers are rapidly following suit. In 2005, the Centers for Medicare and Medicaid Services (CMS) added procedure codes for intermediate and intensive smoking cessation visits:
G0375 Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes.
Short descriptor Smoke/tobacco counseling 3-10
G0376 Smoking and tobacco-use cessation visit; intensive, greater than 10 minutes.
Short descriptor Smoke/tobacco counseling greater than 10
G0375 pays approximately $13; G0376 pays approximately $25. The exact payment depends on your geographic practice cost index (GPCI) as determined by CMS.
These codes do not modify coverage for minimal smoking cessation counseling (3 minutes or less in duration), which is considered covered as part of each evaluation and management (E/M) visit, and therefore is not separately billable.
2 procedures in 10 days will trigger bundling
If the physician is taking the patient to surgery to do only the keloid excision, you have several codes to select from, depending on the type of closure. The excision of the keloid scar would be reported using 11400–11406 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs), where the code selected depends on the documented size of the scar removed.
If it is simple closure, no additional code is reported, but if the closure is either intermediate or complex, you will add a code from the repair section (12031–12037 or 13100–13102). But again the size in centimeters must be documented in order to use these codes.
Also remember that if the surgeon performs the cesarean within 10 days of the keloid excision, he/she will be in the global period for these codes and might have to use a modifier -79 (Unrelated procedure or service by the same physician during the postoperative period) on the global OB code you report. If the keloid is excised at the time of the cesarean, it will be included by most payers as part of establishing the operative site and incision closure.
If the physician is taking the patient to surgery to do only the keloid excision, you have several codes to select from, depending on the type of closure. The excision of the keloid scar would be reported using 11400–11406 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs), where the code selected depends on the documented size of the scar removed.
If it is simple closure, no additional code is reported, but if the closure is either intermediate or complex, you will add a code from the repair section (12031–12037 or 13100–13102). But again the size in centimeters must be documented in order to use these codes.
Also remember that if the surgeon performs the cesarean within 10 days of the keloid excision, he/she will be in the global period for these codes and might have to use a modifier -79 (Unrelated procedure or service by the same physician during the postoperative period) on the global OB code you report. If the keloid is excised at the time of the cesarean, it will be included by most payers as part of establishing the operative site and incision closure.
If the physician is taking the patient to surgery to do only the keloid excision, you have several codes to select from, depending on the type of closure. The excision of the keloid scar would be reported using 11400–11406 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs), where the code selected depends on the documented size of the scar removed.
If it is simple closure, no additional code is reported, but if the closure is either intermediate or complex, you will add a code from the repair section (12031–12037 or 13100–13102). But again the size in centimeters must be documented in order to use these codes.
Also remember that if the surgeon performs the cesarean within 10 days of the keloid excision, he/she will be in the global period for these codes and might have to use a modifier -79 (Unrelated procedure or service by the same physician during the postoperative period) on the global OB code you report. If the keloid is excised at the time of the cesarean, it will be included by most payers as part of establishing the operative site and incision closure.
Modifier needed to bill for anesthesia
If you did perform the version procedure as well as providing the anesthesia to the patient, you would need to indicate this by adding a modifier -47 (Anesthesia by surgeon) to code 59412 (External cephalic version, with or without tocolysis). You would then report a 2nd code for the type of regional anesthesia you administered. For instance, if you used epidural anesthesia, you would report 59412-47, 62311 (Injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]).
If you were only providing the anesthesia, then code 01958 is correct, but now the payer is indicating a mismatch between the CPT code and the diagnosis code.
You have indicated that you used code 652.2 (Breech presentation without mention of version). But as you are billing for anesthesia for a version, this code would no longer be correct. In this case, the more correct code would be 652.13 (Breech or other malpresentation successfully converted to cephalic presentation; antepartum condition or complication) if the version was successful or 652.03 (Unstable lie; antepartum condition or complication) if it was not.
If you did perform the version procedure as well as providing the anesthesia to the patient, you would need to indicate this by adding a modifier -47 (Anesthesia by surgeon) to code 59412 (External cephalic version, with or without tocolysis). You would then report a 2nd code for the type of regional anesthesia you administered. For instance, if you used epidural anesthesia, you would report 59412-47, 62311 (Injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]).
If you were only providing the anesthesia, then code 01958 is correct, but now the payer is indicating a mismatch between the CPT code and the diagnosis code.
You have indicated that you used code 652.2 (Breech presentation without mention of version). But as you are billing for anesthesia for a version, this code would no longer be correct. In this case, the more correct code would be 652.13 (Breech or other malpresentation successfully converted to cephalic presentation; antepartum condition or complication) if the version was successful or 652.03 (Unstable lie; antepartum condition or complication) if it was not.
If you did perform the version procedure as well as providing the anesthesia to the patient, you would need to indicate this by adding a modifier -47 (Anesthesia by surgeon) to code 59412 (External cephalic version, with or without tocolysis). You would then report a 2nd code for the type of regional anesthesia you administered. For instance, if you used epidural anesthesia, you would report 59412-47, 62311 (Injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]).
If you were only providing the anesthesia, then code 01958 is correct, but now the payer is indicating a mismatch between the CPT code and the diagnosis code.
You have indicated that you used code 652.2 (Breech presentation without mention of version). But as you are billing for anesthesia for a version, this code would no longer be correct. In this case, the more correct code would be 652.13 (Breech or other malpresentation successfully converted to cephalic presentation; antepartum condition or complication) if the version was successful or 652.03 (Unstable lie; antepartum condition or complication) if it was not.
Few payers deny unlisted procedures
2 options
This leaves you with 2 coding options. Because the cervix is part of the uterus, the code 58578 (Unlisted laparoscopy procedure, uterus) would be appropriate. If you choose this option, you would report 58661, 58578-51. Alternatively, you could add a modifier -22 (Unusual procedural services) to code 58661. Whichever option you choose, you will need to send documentation with the claim to explain the unlisted procedure or the additional work.
I prefer the first option because it will give you the opportunity to set your fee to account for the actual work performed.
Most payers will not deny unlisted procedures so long as they are not considered investigational or experimental, a concept that should not apply to this surgery.
2 options
This leaves you with 2 coding options. Because the cervix is part of the uterus, the code 58578 (Unlisted laparoscopy procedure, uterus) would be appropriate. If you choose this option, you would report 58661, 58578-51. Alternatively, you could add a modifier -22 (Unusual procedural services) to code 58661. Whichever option you choose, you will need to send documentation with the claim to explain the unlisted procedure or the additional work.
I prefer the first option because it will give you the opportunity to set your fee to account for the actual work performed.
Most payers will not deny unlisted procedures so long as they are not considered investigational or experimental, a concept that should not apply to this surgery.
2 options
This leaves you with 2 coding options. Because the cervix is part of the uterus, the code 58578 (Unlisted laparoscopy procedure, uterus) would be appropriate. If you choose this option, you would report 58661, 58578-51. Alternatively, you could add a modifier -22 (Unusual procedural services) to code 58661. Whichever option you choose, you will need to send documentation with the claim to explain the unlisted procedure or the additional work.
I prefer the first option because it will give you the opportunity to set your fee to account for the actual work performed.
Most payers will not deny unlisted procedures so long as they are not considered investigational or experimental, a concept that should not apply to this surgery.