ObGyns stand to benefit from new Current Procedural Terminology (CPT) codes that capture more of the specifics of procedures such as laparoscopic hysterectomy, and provide codes for newer kinds of services such as prenatal nuchal translucency screening and genetic counseling. A downside for 2007—getting accustomed to the renumbered codes for bone density and breast imaging.
Laparoscopic hysterectomy codes get specific
58541 Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less
58542 …with removal of tube(s) and/or ovary(s)
58543 Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than
250 g
58544 …with removal of tube(s) and/or ovary(s)
Nuchal translucency: Document the detail
76813 Ultrasound, pregnant uterus, real time with image documentation, 1st-trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or 1st gestation
76814 …each additional gestation
Reimbursement should become routine for 1st-trimester nuchal translucency ultrasound imaging.
Coding has been a challenge; in fact, ACOG only recommended reporting the unlisted code 76999 (unlisted ultrasound procedure [eg, diagnostic, interventional]), which requires submission of documentation to make the case for payment. The test is normally performed between 11 and 13 weeks’ gestation.
When measured correctly, nuchal translucency thickness is a powerful marker in Down syndrome screening in the late first trimester
Even when the payer does not require it, documentation is important. Nuchal translucency ultrasound documentation should include:
- the fetal crown–rump length
- verification of the sagittal view of the fetal spine
- 3 measurements of the maximum thickness of the subcutaneous translucency between the skin and the soft tissue overlying the cervical spine
- as with all ultrasound procedures, image documentation and a final written report
Special training is required by the sonographer or physician who performs this measurement. So be aware that the payer may have rules to ensure such training.
Different codes for initial and recurrent cancer
58950 Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy
Primary malignancy resections will continue to be reported with the existing code numbers 58950 through 58952. To make the point clear, CPT revised the wording of the base code, 58950, to specify the initial operation.
58957 Resection (tumor debulking) of recurrent ovarian, tubal, primary peritoneal, uterine malignancy (intra-abdominal, retroperitoneal tumors), with omentectomy, if performed
58958 …with pelvic lymphadenectomy
Unlike other codes for malignancy in the female genitourinary section of CPT, the above 2 new codes specify a broader range of cancers to include uterine malignancy.
Previously, code 49200 or code 49201 (excision or destruction, open, intra-abdominal or retroperitoneal tumors or cysts or endometriomas) would have been as reported for recurrent uterine malignancy.
Do not report these codes in addition: 38770 and 38780 (removal of pelvic or retroperitoneal lymph nodes), 44005 (enterolysis), 49000 (exploratory laparotomy), 49200–49215 (open excision of tumors), 49255 (omentectomy), or 58900–58960 (removal of tubes and ovaries).
New technologies
Uterine artery embolization
37210 Uterine artery embolization
The new code includes vascular access, vessel selection, injection of the material, intraprocedure mapping, and all radiological supervision and interpretation, including image guidance.
Genetic counseling
96040 Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/family
This code is good news for practices that use the services of a genetic counselor. Need, content, and total time must be documented in the report. However, Medicare has assigned no physician relative value units to this new code because they consider it bundled into any E/M service. Check with your payers about separate reimbursement for this service.
| OLD | NEW | |
| BONE DENSITY | ||
| CT, bone mineral density study 1 or more sites | ||
| Axial skeleton (eg, hips, pelvis, spine) | 76060 | 77078 |
| Appendicular skeleton (peripheral) (eg, radius, wrist, heel) | 76061 | 77079 |
| Dual-energy X-ray absorptiometry, bone-density study 1 or more sites | ||
| Axial skeleton | 76065 | 77080 |
| Appendicular skeleton | 76067 | 77081 |
| Vertebral fracture assessment | 76077 | 77082 |
| Radiographic absorptiometry (eg, photodensitometry, radiogrammetry) 1 or more sites | 76078 | 77083 |
| MAMMOGRAPHY | ||
| Unilateral | 76090 | 77055 |
| Bilateral | 76091 | 77056 |
| Screening mammography, bilateral (2-view film study of each breast) | 76092 | 77057 |
| INTRAOPERATIVE ULTRASOUND | ||
| Ultrasound guidance, intraoperative | 76986 | 76998 |
Elizabeth W. Woodcock
Atlanta-based Elizabeth W. Woodcock is a speaker, trainer, and author specializing in practice management. Among her recent books is Mastering Patient Flow.
It’s likely you counsel your patients about smoking cessation at least once a day, if not more. Do you know that you can be reimbursed for this important service? Medicare and Medicaid pay for 8 visits annually in a 12-month period, and other payers are rapidly following suit. In 2005, the Centers for Medicare and Medicaid Services (CMS) added procedure codes for intermediate and intensive smoking cessation visits:
G0375 Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes.
Short descriptor Smoke/tobacco counseling 3-10
G0376 Smoking and tobacco-use cessation visit; intensive, greater than 10 minutes.
Short descriptor Smoke/tobacco counseling greater than 10
G0375 pays approximately $13; G0376 pays approximately $25. The exact payment depends on your geographic practice cost index (GPCI) as determined by CMS.
These codes do not modify coverage for minimal smoking cessation counseling (3 minutes or less in duration), which is considered covered as part of each evaluation and management (E/M) visit, and therefore is not separately billable.