Hot Coding Topics

Myomectomy Claims: Anatomical Location Is Your Key

Deciding which myomectomy code you’ll report depends on three factors: the approach the ob-gyn uses, the number of myomas, and their weight. Here’s how to translate this information into the correct CPT code every time.

If your ob-gyn performs a hysterectomy, you won’t report the myomectomy separately.

When your ob-gyn performs a myomectomy, he is removing myomas or uterine fibroid tumors. Knowing what type they are will help you to determine your myomectomy code.

Myomas (also known as uterine fibromas) are the most common growth of the female genital tract. They are round, firm, benign masses of the muscular wall of the uterus and are composed of smooth muscle and connective tissue. You’ll see different types of uterine fibroids based on their location:

  • Intracavitary myomas are fibroids inside the uterus.
  • Submucous myomas are partially in the uterine cavity and partially in the wall of the uterus.
  • Subserous myomas are on the outside wall of the uterus.
  • Intramural myomas are in the wall of the uterus; their size can range from microscopic to larger than a grapefruit. These take a lot more effort to remove than a surface myoma.
  • Pedunculated myomas are connected to the uterus by a stalk and are located inside the uterine cavity or on the outside surface.

Myomas often cause or are coincidental with abnormal uterine bleeding, pressure or pain. They are also one of the most common reasons women in their 30s or 40s have hysterectomies, says Peggy Stilley, CPC, COBGC, ACS-OB, director of auditing services at the American Academy of Professional Coders.

However, women who want to have children in the future or simply do not want their uterus removed look for alternative solutions. The following procedures describe abdominal, vaginal, and laparoscopic approaches.

First of all, look at the abdominal approach. When...

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February 5, 2011
Coder's Cranium

59400, 99212, 99213: How to Add Complication Visits to the Global Ob Package

Hint: You can report complications before or after delivery.

You can receive increased reimbursement when your ob-gyn provides additional visits outside of the normal global ob package, but you’ll have to make sure you’ve coded high-risk or complicated obstetrical care correctly – and that means perfecting your ICD-9 coding skills.

Insist on Perfect ICD-9s

You have to link the ICD-9 code on the CMS-1500 claim form (boxes 21 and 24E) to an E/M code, for example, to demonstrate the reason for the additional service. You can add this to the claim that includes the global service, or you can submit it as an additional claim.

Example: A 33-year-old patient, gravida 3, para 2 (both normal spontaneous vaginal delivery [NSVD] full term), is seen in the office 19 times due to developing pre-eclampsia. After the delivery, you review the case and find that the patient required six additional visits (beyond the usual 13) for this care. The documentation for three of these visits supports reporting 99212 (Office or other outpatient visit for the evaluation and management of an established patient … Physicians typically spend 10 minutes face-to-face with the patient and/or family), while three of the visits have more extensive documentation that supports reporting 99213 (Office or other outpatient visit for the evaluation and management of an established patient … Physicians typically spend 15 minutes face-to-face with the patient and/or family).

In addition, after delivery, the patient experiences prolonged pain and irritation due to a hemorrhoid. The ob-gyn sees her for a thrombosed hemorrhoid, which he incises in the office two weeks post-delivery. Finally, the ob-gyn rechecks the patient at her six weeks postpartum visit.

Break it down: When coding for this patient, remember the claim form must note both the CPT codes describing the additional services, as well as the diagnoses that...

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November 14, 2010
Hot Coding Topics

ICD-9 2011: 752.3x, V13, V91 Offer Obs More Anomaly, Status Options

Three scenarios show you where to brush up before Oct. 1 hits.

October 1 means it’s time to apply the new 2011 diagnosis codes affecting your obgyn practice, which include new uterine anomaly, placenta, and personal history diagnoses. Are you ready? Take this challenge to find out.

Add Uterine Anomalies to Your Diagnosis Arsenal

Scenario 1:

A) 752.31

B) 752.33

C) 752.35

D) None of the above.

E) All of the above.

Solution 1: E. The American Society of Reproductive Medicine (ASRM) identified seven types of uterine anomalies: agenesis, unicornuate, didelphus, bicornuate, septate, arcuate, and DES related anomalies. Of these, only didelphus and DES related anomalies have unique ICD-9 codes prior to Oct. 1: 752.2 and 760.76, respectively. For the other anomalies, you have no specific diagnosis recourse.

However, as of Oct. 1, you’ll be able to differentiate between these different types, and payers will translate these codes into specific gynecologic and obstetric implications and management. They are:

  • 752.31 – Agenesis of uterus
  • 752.32 - Hypoplasia of uterus
  • 752.33 – Unicornuate uterus
  • 752.34 – Bicornuate uterus
  • 752.35 – Septate uterus
  • 752.36 – Arcuate uterus
  • 752.39 — Other anomalies of uterus.

Multiple Placentae? Make Use of New Dx

Scenario 2: The ob-gyn delivers dichorionic/diamniotic twins vaginally. After October 1, how should you report this?

A) 59400, 59409-51, 651.01, V91.00, V27.2

B) 59400, 59409-51, 651.01, V91.01, V27.2

C) 59400, 59409-51, 651.01, V91.02, V27.2

D) 59400, 59409-51, 651.01, V91.03, V27.2

E) 59400, 59409-51, 651.01, V91.09, V27.2

Solution 2: D. You would report 59400 (Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care) for the first baby and 59409-51 (Vaginal delivery only [with or without episiotomy and/or forceps]; Multiple procedures) for the second. To support these CPT codes, you’d link each to 651.01 (Twin pregnancy; delivered) and...

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September 20, 2010
CCI / CPT / Hot Coding Topics / modifier 59 / NCCI

CCI 16.1: Seize the Opportunity to Report 0193T — But Don’t Get Tripped Up By These Edits

Overlooking these new Interstim and hemorrhoid destruction bundles could mean denial headaches.

Payers like Noridian Part B will cover the female stress urinary incontinence treatment code 0193T, but before you submit a 0193T claim, you’ll have to check with the...

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April 14, 2010
Coder's Cranium

Don’t Miss Out on E/M Fees by Initiating Ob Record Too Soon

Test your ob record skills with this four part challenge.

If your ob-gyn simply confirms a patient’s pregnancy during an office visit, you’ll be able to report V72.42 (Pregnancy, confirmed). But when should you start the ob record? Take this...

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March 22, 2010
Coding Challenge / ICD-10 / ICD-9

Ob-gyn Coding Challenge: Deliver Postpartum V Codes With Care

Bonus: Get exposure to ICD-10 coding equivalents.

Question: A mentally-challenged patient who delivered at home was admitted to the hospital for postpartum care. The patient delivered the placenta at home, and once admitted, she had no complications, but the ob-gyn…

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March 10, 2010
Coder's Cranium / ICD-10 / ICD-9

Pick the Right ICD-9, ICD-10 Code for Postmenopausal Abnormalities

Do N95.0 and N95.2 look foreign? Get your ob-gyn ICD-10 equivalents now. Spare yourself denial hot flashes by taking this three-part postmenopausal abnormality scenario challenge. Fill In These Blanks Using Your ICD-9 Book Question 1: Your ob-gyn sees a post menopausal patient with an inflamed vagina because the tissues are thinning and shrinking. The ob-gyn notes decreased vaginal [...] Related articles:

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January 26, 2010
CCI / Hot Coding Topics / modifier 59 / mutually exclusive

Ob-Gyn CCI 16.0: Hysterectomy Coding

Here’s where you can bypass the edits with modifier 59. The Correct Coding Initiative (CCI) version 16.0 didn’t overlook the hysterectomy, vaginal graft, and colpopexy codes — nor should you. To make sense of the deletions, break these additions into mutually exclusive and non-mutually exclusive. Note: In all these cases — except those involving the anesthetic injection [...] Related articles:

  1. Hysterectomy Coding Simplified: Look at Weight, Removal Severing these ligaments clues you into whether ob-gyn removed...
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  3. 3 Steps Take the Guesswork Out of Coding Vaginal Cuff Repairs Find out what colporrhaphy code you’ll use for an...

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January 22, 2010
Coding Challenge / Pain Management

How Do I Code an Epidural Blood Patch on Same Day as L&D

Don’t forget to double-check these 2 things to find the correct code. Question: How do I code an epidural blood patch procedure on the same day as labor and delivery? Should I include a modifier? Answer: Administering a blood patch on the same day as labor and delivery is unusual because most physicians try to manage spinal [...] Related articles:

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December 2, 2009