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Reimbursement Advisor


CPT 2004 highlights: Advanced procedures, HIPAA compliance

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.”

January 2004 · Vol. 16, No. 1

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

Code 58340 has been revised to reflect more current terminology. The term “hysterosonography” has been changed to “saline infusion sonohysterography.” A similar change applies to the radiological supervision code 76831 [saline infusion sonohysterography, including color flow Doppler, when performed]. This change does not alter the use of the codes in any way.

Reproductive medicine procedures

This new section of laboratory codes accommodates the technologic advancements and changing practice in reproductive medicine.

Symbols

This article uses the standard CPT symbols:

  • Codes new to CPT 2004
  • Codes revised in CPT 2004

Indentation

When a code is followed by 1 or more indented codes, the indented text replaces everything following the semicolon in the initial code.

The procedures are grouped into 3 categories, by type of procedure:

  • Oocyte/embryo culture and fertilization techniques;
  • Oocyte/embryo biopsy techniques; and
  • Freezing, thawing, and storage techniques.

These are nonphysician procedures performed in highly specialized clinical laboratories; any physician services provided at the same time may be reported in addition. In creating this new section, codes 89252 and 89256 were deleted and renumbered to 89280/89281 and 89352, respectively.

In addition, there are 2 new Category III codes for cryopreservation of tissue and oocytes. If the procedure performed matches one of these new Category III codes, it must be reported rather than an unlisted service code. The new and revised codes can be found in the Table.

TABLE

Reproductive medicine procedures

OOCYTE/EMBRYO CULTURE AND FERTILIZATION TECHNIQUES

89250

Culture of oocyte(s)/embryo(s), less than 4 days;*

89251

with coculture of oocyte(s)/embryos†

• 89268

Insemination of oocytes

• 89272

Extended culture of oocyte(s)/embryo(s), 4-7 days‡

• 89280

Assisted oocyte fertilization, microtechnique; less than or equal to 10 oocytes

• 89281

greater than 10 oocytes

OOCYTE/EMBRYO BIOPSY TECHNIQUES

• 89290

Biopsy, oocyte polar body or embryo blastomere, microtechnique (for preimplantation genetic diagnosis); less than or equal to 5 embryos

• 89291

greater than 5 embryos

FREEZING, THAWING, AND STORAGE TECHNIQUES

89258

Cryopreservation; embryo(s)

• 89335

Cryopreservation, reproductive tissue, testicular

• 89342

Storage (per year); embryo(s)

• 89343

sperm/semen

• 89344

reproductive tissue, testicular/ovarian

• 89346

oocyte

• 89352

Thawing of cryopreserved; embryo(s)

• 89353

sperm/semen, each aliquot

• 89354

reproductive tissue, testicular/ovarian

• 89356

oocytes, each aliquot

CATEGORY III CODES

• 0058T

Cryopreservation of reproductive tissue, ovarian

• 0059T

Cryopreservation of oocyte(s)

* You can now use code 89250 to report the culture of immature oocytes. Fertilization and insemination are no longer considered part of this code, and thus are reported separately.

† Code 89251 represents the additional work of the microfertilization of more than 10 oocytes.

‡ Use code 89272 to report separate techniques for additional cultures over a 4- to 7-day period and in addition to code 89250.

Staying hip to HIPAA: Category II codes

This new section, which adds supplemental tracking codes for performance measurements, was created in an effort to comply with HIPAA regulation requirements for the code set. These codes will not affect reimbursement, but are meant to decrease the need for record abstraction and chart review. Use of these codes, it is hoped, will facilitate data collection about quality of care. Coders should be aware of the following:

  • The use of these codes is optional; they may not be substituted for the regular Category I CPT codes.
  • The codes describe components typically included in an evaluation and management service, as well as test results that are part of the laboratory test/procedure.
  • The codes are assigned no relative value units.
  • New codes for this section will be released semiannually. Updates can be found on the AMA/CPT Web site (www.ama-assn.org/ama/pub/category/3885.html).

The codes will be published in the CPT each year.

The Category II codes effective January 1, 2004, are:

  • 0001FBlood pressure, measured
  • 0002FTobacco use, smoking, assessed
  • 0003FTobacco use, nonsmoking, assessed
  • 0004FTobacco use cessation intervention, counseling
  • 0005FTobacco use cessation intervention, pharmacologic therapy
  • 0006FStatin therapy, prescribed
  • 0007FBeta-blocker therapy, prescribed
  • 0008FAngiotensin-converting enzyme inhibitor therapy, prescribed
  • 0009FAnginal symptoms and level of activity, assessed
  • 0010FAnginal symptoms and level of activity, assessed using a standardized instrument (eg, Canadian Cardiovascular Society Classification-CCSC-System, Seattle Angina Questionnaire-SAQ)
  • 0011FOral antiplatelet therapy, prescribed (eg, aspirin, clopidogrel/Plavix, or combination of aspirin and dipyridamole/Aggrenox)

BEST OF THE REST

Surgical procedures Urinary system.

• 53500Urethrolysis, transvaginal, secondary, open, including cystourethroscopy (eg, postsurgical obstruction, scarring)

This new code is for the treatment of obstructive voiding caused by periurethral scarring, which can occur following a urethral suspension procedure, such as a bladder neck suspension. The procedure associated with this new code usually involves the dissection, lysis, and removal of the periurethral scar tissue, as well as mobilization of the urethra away from the surrounding tissues. This code also includes cystourethroscopy (52000), which is sometimes performed to check the urethra after the procedure is done.

In addition, CPT indicates that if urethrolysis is performed via a retropubic rather than vaginal approach, unlisted code 53899 should be reported instead of 53500.

Medicine code changes

Miscellaneous services. Code 99025 [initial (new patient) visit when starred (*) surgical procedure constitutes major service at that visit] was deleted, due to the elimination of all starred procedures in CPT 2004. Thus, billing for an evaluation and management service on the same date as an office (minor) procedure will depend on the documentation. The evaluation and management service must be separate and significant from the office service. For global periods assigned to individual CPT procedures codes, coders should either reference the Medicare global periods or consult with their individual private payers, who may assign global days based on community standards.

A new instruction for 99080 [special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form] indicates that this code should not be reported with the Work Related or Medical Disability Evaluation codes 99455 and 99456, since these codes include completion of Workmen’s Compensation forms.

Additional changes to this section include:

  • 99024 Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure
  • 99050 Services requested after posted office hours in addition to basic service

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