3 FAQs Banish Your Coding Frustrations on Vaginal Cuff Repair

Find out what colporrhaphy code you’ll use for an injury repair.

If you’re stuck trying to figure out what code to use for a vaginal cuff repair, you should ask yourself one main question: Why did the ob-gyn need to perform the repair?  The answer is the best way to decide what code (and possibly modifiers) to choose.  Follow these three expert steps, and you’ll find the solution to one of the most frequently asked questions in an ob-gyn office: “Which CPT® code should I use for repair of vaginal cuff?”

Q1: How Do I Decide What Repair Code to Use?

The first thing you should do when the ob-gyn performs a vaginal cuff repair is examine the operative report to determine why the patient required the repair, says Cindy Foley, Billing Manager for three separate gynecology practices in Syracuse, N.Y.

Q2: If Repair Dealt With Loose Sutures, What Should I Do?

You read your op notes and discovered the vaginal cuff repair dealt with loose sutures.  Suppose the patient, who underwent a total abdominal hysterectomy (58150, Total abdominal hysterectomy corpus and cervix], with or without removal of tube[s],with or  without removal of ovary[s]), needs to return to the operating room for a vaginal cuff repair because the original sutures became loose and a simple re-closure is documented.  In this case, you should report 58999 (Unlisted procedure, female genital system [nonobstetrical]). You would also need to submit your op report along with a cover letter that explains in simple, straightforward language exactly what your ob-gyn did, says Melanie Witt, RN, COBGC, MA, an ob-gyn coding expert based in Guadalupita, N.M.

Remember to explicitly reference the nearest equivalent listed procedure in your explanatory note. For example, you might consider comparing the work to 12020 (Treatment of superficial wound dehiscence; simple closure), which...

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5 Tips Lead You to G0438, G0439 Coding Success

Boost your bottom line by reporting new annual wellness visits correctly.  If you want your annual visit claims to be picture perfect in 2011, then follow these five tips to avoid future denials and keep your physician’s claim on the fast track to success.

Background: The Affordable Care Act (ACA) extended preventive coverage to more than 88 million patients covered by health insurance, and Medicare has codified that benefit in the form of an annual wellness visit. Medicare valued the new annual wellness codes based on a level 4, problem-oriented new and established E/M service.

The two new codes are:

G0438 — Annual wellness visit; includes a personalized prevention plan of service (PPPS), first visit

G0439 — Annual wellness visit; includes a personalized prevention plan of service (PPPS), subsequent visit.

Tip 1: Apply G0438 to Second Year of Coverage

Be wary of applying these codes to new Medicare patients coming in to your physician’s practice in 2011.  The reason is that Medicare will only reimburse the initial visit (G0438) during the second year the patient is eligible for Medicare Part B. In other words, during the first year of the patient’s coverage, Medicare will only cover the Initial Preventive Physical Exam (IPPE), also known as the Welcome to Medicare exam.

Tip 2: CMS Limits G0438 to One Physician

If your FP sees the patient for the initial visit (G0438) and the patient sees a different physician for the next annual wellness visit, that second physician will only receive reimbursement for the subsequent visit (G0439), despite having never seen the patient before.

Here’s why: CMS has indicated that when a patient returns to the same or new physician in a third year, they might only pay for the subsequent visit, says Melanie Witt, RN, COBGC, MA, an...

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Report Picture Perfect Annual Wellness Visits With These 5 Tips

The Affordable Care Act (ACA) extended preventive coverage to more than 88 million patients covered by health insurance, and Medicare has codified that benefit in the form of an annual wellness visit. Medicare valued the new annual wellness codes based on a level 4, problem-oriented new and established E/M service. The two new codes are:

  • G0438 – Annual wellness visit; includes a personalized prevention plan of service (PPPS), first visit
  • G0439 – Annual wellness visit; includes a personalized prevention plan of service (PPPS), subsequent visit.

Tip 1: Apply G0438 to Second Year of Coverage

Be wary of applying these codes to new Medicare patients coming in to your physician’s practice in 2011.

The reason is that Medicare will only reimburse the initial visit (G0438) during the second year the patient is eligible for Medicare Part B. In other words, during the first year of the patient’s coverage, Medicare will only cover the Initial Preventive Physical Exam (IPPE), also known as the Welcome to Medicare exam.

Tip 2: CMS Limits G0438 to One Physician

If your FP sees the patient for the initial visit (G0438) and the patient sees a different physician for the next annual wellness visit, that second physician will only receive reimbursement for the subsequent visit (G0439), despite having never seen the patient before.

CMS has indicated that when a patient returns to the same or new physician in a third year, they might only pay for the subsequent visit, says Melanie Witt, RN, COBGC, MA, an independent coding consultant in Guadalupita, N.M. “It is therefore important that you convey this information to any new physician the patient sees.”

Tip 3: Add Preventive Service Codes, If Performed

You can bill the new annual visit codes in addition to any other preventive service, such as G0102 (Prostate cancer...

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Ob-gyn Challenge: Take the Pressure Out of a 3D US Coding

No severe problems? You may have trouble with reimbursement. Question: The ob-gyn performed and OB ultrasound (US) on a patient. Can I bill 76376 in addition to the ultrasound if the ob-gyn used 3D? Montana Subscriber Answer: Yes. You can report a 3D procedure with 76805 (Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, [...] Related articles:

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8 Simple Steps Organize Your Op Note Coding

This aspect of op note coding is the “horse that pulls the cart.” Stuck on how to tackle this op note or those sitting on your desk? Follow this advice, provided by Melanie Witt, RN, CPC, COBGC, MA, an ob-gyn coding expert based in Guadalupita, N.M. and co-presenter of the “Ob-Gyn Op Notes” session at the [...] Related articles:

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CMS Will Cover HIV Screening As Preventive Care Service

Bonus: Effective immediately! You’re probably accustomed to CMS taking away coverage for certain services, but in an early holiday gift to practices, CMS has actually added a preventive care service to its roster of covered screenings, effective immediately. CMS issued a final decision on Dec. 8 declaring that HIV testing will now be covered for Medicare beneficiaries [...] Related articles:

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Coding News Travels to Florida for 2010 Updates

Do you have a question about how you should code in 2010? Write us and we’ll ask the experts. Princesses have their castles, but the big news in Orlando this weekend is that the Coding Queens are coming to town! This week in Orlando, nationally known coding & billing experts like Marvel Hammer, Melanie Witt, Leslie Johnson [...] Related articles:

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What Diagnosis Code Do I Use for a Fern Test?

Ob-Gyn Coding Tip: Scan for leukorrhea signs when fluid is present. Question: My physician performs a fern test on a patient, trying to rule out rupture of membranes. What diagnosis code applies? Answer: If the test result proves positive, then you should report 658.13 (Premature rupture of membranes with antepartum condition or complications). Otherwise, use V89.01 [...] Related articles:

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