4 CPT gems for 2005

Still no uterine artery Doppler code

For this, ACOG recommends continuing to use codes 76827 or 76828—but a closer code might be 93976 (Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study).

Note the slight change in nomenclature for 76827. The phrase “cardiovascular system” was removed for CPT 2005.

ULTRASOUNDNew requirement: Images must be recorded

Most noteworthy of the new ultrasound guidelines is the requirement that an image be recorded. Permanently recorded images with measurements are required for all diagnostic ultrasound examinations (when such measurements are clinically indicated).

Ultrasound guidance procedures also require permanently recorded images of the site to be localized, and a documented description of the localization process, either separately or within the procedure report for which the guidance is utilized. A final, written report should be placed in the patient’s medical record.

For anatomic regions that have “complete” and “limited” ultrasound codes:

• Note the elements that comprise a “complete” exam, and include in the report a description of each or the reason an element could not be visualized.
  
• Use the “limited” code—once per patient exam session—if reporting less than the required elements for a complete exam (eg, limited number of organs or limited portion of region evaluated).
  
• Do not report a “limited” exam for the same exam session as a “complete” exam of that same region.
  

Use of ultrasound without thorough evaluation of organ(s) or anatomic region, image documentation, and final written report is not separately reportable.

Nonobstetric ultrasound

When to code complete ultrasound. The code for complete nonobstetric ultrasound (76856, Ultrasound, pelvic [nonobstetric], B-scan and/or real time with image documentation; complete) encompasses the comprehensive evaluation of the female pelvic anatomy, including:

• measurement of uterus and adnexal structures
  
• measurement of the endometrium
  
• measurement of the bladder (when applicable)
  
• description of any pelvic pathology
  

• focused examination limited to the assessment of 1 or more elements listed in code 76856, and/or
  
• reevaluation of 1 or more pelvic abnormalities previously seen on ultrasound.
  

ALSO NOTABLETotal omentectomy

Previously, no code existed to describe removal of the uterus and omentum for malignancy without lymph-node dissection. But when omental metastasis is present, pelvic and paraaortic lymph node dissection for staging is not usually necessary, since the disease has already spread into the abdominal cavity. New code 58956 addresses this problem. To report this code, the documentation must clearly indicate a total omentectomy (removal of both the lesser and greater omentum, also referred to as a supracolic omentectomy).

Debridement of genitalia

Three codes address debridement of the external genitalia and perineum skin for necrotizing soft tissue infection.

Screening for chromosome abnormalities

A new laboratory services code, 84163, describes the pregnancy-associated plasma protein-A (PAPP-A) screening test, used to identify women at highest risk of carrying a fetus with Down Syndrome, trisomy 18, or other chromosomal abnormality.

Oocyte storage

A revision to make “oocyte” plural in code 89346 (storage [per year]; oocytes) clarifies that each oocyte stored is not coded separately.

New appendices

Appendix F lists codes exempt from modifier -63 (Procedure performed on infants less than 4 kg).

Appendix G lists procedures that include conscious sedation. A new symbol, ••, was created to denote this for the individual codes included in this section. The only Ob/Gyn-specific code that carries this symbol is 58823 (drainage of pelvic abscess, transvaginal or transrectal approach, percutaneous [eg, ovarian, pericolic]).

Appendix H is an alphabetic index of Category II code performance measures (the index lists them by clinical condition or topic), and includes a brief description of the performance measure and its source.

Appendix I lists genetic testing code modifiers. Report these with the molecular lab procedures related to genetic testing. The modifiers are categorized by mutation: The first digit indicates the disease category, the second denotes the gene type. For instance, 0A signifies testing for the BRCA1 gene.