Reimbursement Advisor

Keeping up with CPT 2003

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What do obstetric ultrasounds, large-uterus vaginal hysterectomies, and body-fat-composition tests have in common? They all got coding makeovers for 2003. Read on for details on these and more OBG-specific changes.


 

KEY POINTS
  • Obstetric ultrasound codes have been revamped to allow maternal-fetal specialists to report accurately the ultrasound procedures they perform.
  • Several Ob/Gyn-relevant Category III codes—which represent emerging technology—have been added, though payers may not yet reimburse for these procedures.
  • CPT changed the uterine-fibroid removal codes to account for the more-involved surgical work required for larger or multiple fibroids.
  • Hysterectomy codes were revised to account for the additional work involved in removing a large uterus vaginally.
There’s good news and bad news for OBG coders in 2003. The bad news is that the wealth of new Current Procedural Terminology (CPT) codes means practices must make some serious changes to their office procedures encounter form. The good news is that these long-awaited changes should make it easier for physicians to communicate to insurers the type and difficulty of many routine procedures.

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

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

Updated pap smear codes

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

  • 88174 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision
  • 88175 with screening by automated system and manual rescreening, under physician supervision
For manual screening, coders should refer to codes 88142 and 88143.

Counting leukocytes, testing semen

  • 89055 leukocyte count, fecal
This new code, added to describe laboratory testing for fecal leukocytes, replaces the Health Care Financing Administrators Common Procedure Coding System (HCPCS) Level II G code G0026 (fecal leukocyte examination).
  • 89300 Semen analysis; presence and/or motility of sperm including Huhner test (post coital);
  • 89310 Motility and count, not including Huhner test.
While 89300 has not changed, 89310 was revised to specifically exclude Huhner testing. It will replace the HCPCS Level II G code G0027 (semen analysis presence and/or motility of sperm excluding Huhner test).

The biggest change: diagnostic ultrasound codes

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

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

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

  • 76801 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (
  • 76802 each additional gestation (List separately in addition to code for primary procedure performed.)
(Use 76802 in conjunction with 76801.)
  • 76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (14 weeks 0 days), transabdominal approach; single or first gestation
  • 76810 each additional gestation (List separately in addition to code for primary procedure performed.)
(Use 76810 in conjunction with 76805.)
  • 76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation
  • 76812 each additional gestation (List separately in addition to code for primary procedure performed.)
(Use 76812 in conjunction with 76811.)

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