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CPT 2004 highlights: Advanced procedures, HIPAA compliance

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New codes for sophisticated intrauterine fetal procedures, a laparoscopic approach to posthysterectomy prolapse repair, and the newly enforceable HIPAA laws—here are the “best of the best” for 2004, and the “best of the rest.”


 

Maternal-fetal medicine physicians, infertility specialists, gynecologic surgeons, and the folks behind HIPAA top the list of professionals cheering the updates to Current Procedural Terminology (CPT) 2004.

Among the revisions making the biggest splash for Ob/Gyns in this year’s manual:

  • the addition of new codes for fetal surgical procedures—interventions that previously could be reported only with an unlisted procedure code;
  • a new code for laparoscopic colpopexy;
  • a revamp of the infertility lab procedure codes to incorporate advanced procedures utilizing newer technology; and
  • the addition of the new Category II codes—necessary to bring CPT in line with HIPAA requirements, thus allowing it to remain the coding system of choice for physician services.

Of course, a number of other changes also may affect Ob/Gyn practice. Thus, a “best of the rest” roundup is also included.

BEST OF THE BEST

Fetal intrauterine procedures

By adding 5 new codes for fetal intrauterine surgical procedures—including an “unlisted procedure” code—to the “maternity care and delivery” section, CPT brings out of the investigational arena some techniques that can be used to treat the fetus in utero or aid in the evaluation of the fetal condition.

Note that since all of the codes include ultrasound guidance, you will not need a second code from the radiology section.

• 59070 Transabdominal amnioinfusion, including ultrasound guidance

The procedure itself involves performing an amniocentesis, then guiding the needle between the fetal extremities. Sterile saline is instilled under continuous ultrasound until adequate visualization of the fetal anatomy is possible. After the needle is removed, a detailed ultrasound of the fetus is performed. This can be coded separately by reporting 76811 (as well as 76812 if there is more than 1 fetus). Note, however, that this code would not be reported if the sterile saline is introduced via the cervix, as this is not an “invasive” procedure; instead, use the unlisted code 59899.

• 59072 Fetal umbilical cord occlusion, including ultrasound guidance

This is performed when 1 fetus in a set of monochorionic twins has a severe fetal anomaly. In the procedure, blood flow from the umbilical cord to the affected fetus is occluded, using either laser, suture, or bipolar coagulation. Ultrasound, including color Doppler, is used to confirm complete absence of flow through the occluded cord. Because the purpose of the Doppler is to check the success of the occlusion, it is not coded separately.

• 59074 Fetal fluid drainage (eg, vesicocentesis, thoracocentesis, paracentesis), including ultrasound guidance

For these procedures, the surgeon aspirates fluid from fetal body cavities or organs to help evaluate or treat congenital abnormalities. Fetal bladder aspiration is one example; in this procedure, the physician directs the needle into the fetal bladder and aspirates fetal urine. The patient is monitored after the needle is removed and an ultrasound is performed again in about 1 hour to check for bladder refilling. Since the postprocedure ultrasound is diagnostic in nature, it can be billed for separately, but some payers may conclude that it is part of the procedure.

• 59076 Fetal shunt placement, including ultrasound guidance

This procedure involves the percutaneous placement of a double-pigtailed catheter into the area that requires drainage (the fetal bladder or the thorax, if the problem is pleural effusion). Once the catheter is in place, the other end is inserted into the amniotic cavity, so the fluid can travel into this space. The patient and fetus are monitored for an hour or longer and a repeat scan is performed to evaluate drainage and reaccumulation of amniotic fluid. In this case, the repeat scan will probably be considered part of the procedure, as it is done to check the intervention’s success.

• 59897 Unlisted fetal invasive procedure, including ultrasound guidance

Laparoscopic colpopexy

• 57425 Laparoscopy, surgical, colpopexy (suspension of vaginal apex)

With many surgeons now performing colpopexy laparoscopically, rather than abdominally, this new code (added to the “female genital system” section of “Surgical procedures”) is sure to solve some coding headaches.

For this procedure, which is normally done on patients with uterovaginal prolapse or prolapse of the vaginal vault following a hysterectomy, a Halban or McCall’s culdoplasty is performed to obliterate the cul-desac,and a graft is secured to the pubocervical and rectovaginal fascia. The physician may also do presacral dissection, so that the graft can be secured to the sacrum’s anterior longitudinal ligament. Any adhesions are lysed to gain access to the vaginal apex—this lysis is not normally coded separately.

Also changed in this section:

• 58340 Catheterization and introduction of saline or contrast material for saline infusion sonohysterography or hysterosalpingography

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