ObGyn Medicare and CPT coding changes that could affect your income in 2015
Although Medicare reimbursement looks bleak for the coming year, awareness of some coding changes could help your bottom line
Medicare, on the other hand, has decided to create a G code for tomosynthesis, which is the only code that will be accepted for payment if the patient meets her high-risk criteria for performance of this test.
Under Medicare rules you would report/order the following codes for mammographic services:
- Film (use CPT codes)
- 77056, Mammography; bilateral
- 77057, Screening mammography, bilateral (2-view film study of each breast)
- 2D digital (use G0202, G0204, and G0206)
- G0204, Diagnostic mammography, producing direct digital image, bilateral, all views
- G0206, Diagnostic mammography, producing direct digital image, unilateral, all views
- 3D screening (use G0202 for 2D digital plus the new CPT code 77063 for 3D)
procedure.)
- 3D diagnostic (use G0204 or G0206 for the 2D digital plus the new G code G0279 for 3D)
Modifier 59 becomes more specific
Another Medicare coding change that may affect ObGyns is the addition of new Medicare modifiers that are intended to eventually replace the modifier -59. This new list of modifiers will need to be appended to bundled procedures to more clearly explain why the secondary procedures should be paid separately. At the most recent American Medical Association (AMA) CPT symposium in Chicago, Illinois, CMS medical directors indicated that the new modifiers should be used only when the clinician is given instructions to do so by the carrier. Until then, the modifier -59 should continue to be used by most clinicians.
Here are the new modifiers, with an example of their use with currently bundled procedures that allow a modifier -59 to be used under certain circumstances:
- -XE: Separate encounter (A service that is distinct because it occurred during a separate encounter.) For instance, a patient presents to the office in the morning to have an abscess on her labia near her urethra incised and drained (56405). She returns in the afternoon to have a temporary catheter inserted because she states she cannot urinate and you decide to put in a temporary Foley catheter (51702) until the swelling has gone down. Add the modifier XE to 51702 to indicate it was performed at a different patient encounter.
- -XP: Separate practitioner (A service that is distinct because it was performed by a different practitioner.) Normally, Medicare will reimburse an unaffiliated clinician for performing a procedure that is bundled, since the bundling edits apply to the billing surgeon. But when two physicians from the same practice each are performing a different procedure at the same operative session that would otherwise be bundled, this new modifier will make that clear.
For example, Dr. Bates is performing a laparoscopic paravaginal defect repair (57423) and calls Dr. Clark, a urogynecologist in his practice, to remove severe adhesions from the ureters. The claim should go in under the same tax ID number, with the code 50715 listed first (as it has greater RVUs) and code 57423 reported with the -XP modifier.
- -XS: Separate structure (A service that is distinct because it was performed on a separate organ/structure.) Dr. Scott is performing the removal of endometrial implants around the left fallopian tube and in the cul-de-sac and notices that the right fallopian tube appears closed. He performs chromotubation on the right fallopian tube and notes that the right tube is blocked. Billing in this case would be 58662, 58350-XS.
- -XU: Unusual non-overlapping service (The use of a service that is distinct because it does not overlap usual components of the main service.) Mary has Medicare coverage and presents at 20 weeks 4 days gestation with bleeding and labor pains. Her examination shows bulging membranes that rupture when you attempt to remove the cerclage suture. You note a large rent in the cervix, but cannot get to the cerclage sutures as the patient is in active labor and beginning to bear down. The fetus and placenta are delivered a short time later through the rent in the cervix. You repair the rent in the cervix following delivery.
In this case, code 59400-52 (reduced services since the patient delivered at 20 weeks and there were reduced antepartum services), and 57720-XU because the repair of the cervix is not part of the usual services for a vaginal delivery.
Share your thoughts on this article! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.
