Ob gyn coding: Clue in to these CCI edits prior to choosing 0193T
Overlooking these new Interstim and hemorrhoid destruction bundles could mean denial woes.
Do not let CCI version 16.1's lack of ob-gyn mutually exclusive edits put you into a false sense of security. Here is what you need to know to put off a denial from landing on your desk.
Payers like Noridian Part B will cover the female stress urinary incontinence treatment code 0193T, however, before you submit a 0193T claim, you will have to check with the CCI version 16.1's edits. For example, as of April 1, the work represented by 0193T will include that of cystourethroscopy codes [http://codingnews.inhealthcare.com/hot-coding-topics/ob-gyn-coding-clue-in-to-these-cci-edits-before-you-choose-0193t/] 52000-52001 and 52281.
Look for 0193T in Column 1, Column 2 Position
Last year, CPT added 0193T (Transurethral, radiofrequency micro-remodeling of the female bladder neck and proximal urethra for stress urinary incontinence) to your likely stress urinary incontinence (SUI) treatment coding options. This code covers the Renessa transurethral collagen radiofrequency denaturation procedure. Ob-gyns normally carry out this nonsurgical, minimally invasive alternative for women who have failed other nonsurgical treatments or who are not good candidates for surgery.
What happens: The ob-gyn makes use of controlled heat at low temperatures and aims at tissue in the woman's lower urinary tract. The heat alters the structure of the patient's natural tissue collagen. This aids the firmness of tissue and improves her continence. Even though the ob-gyn may use heat on multiple sites and document multiple cycles, you should go for 0193T to represent all the treatment cycles carried out during an encounter.
With effect from April 1, 0193T will cover the work represented by 52000-52001 (Cystourethroscopy ...) and 52281 (Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or minus meatotomy, with or minus injection procedure for cystography, male or female).
Reaction: These edits do not surprise me at all because 0193T says 'transurethral' which implies the use of the scope," according to Jan Rasmussen, CPC, AGS-GI, ACS-OB, president of Professional Coding Solutions in Eau Claire, Wis. For example, you should always cover "inserting the scope (52000) into the main procedure." As for 55231, "that's a little less obvious,"however CCI probably bundled that as these services may be part of the approach," adds Ramussen.
You should also cover 53660-53666 (Dilation of female urethra...) and 90901 (Biofeedback training by any modality). Correct Coding Initiative describes these edits as "misuse of column two code with column one code (0193T).
Keep in mind: Column one/ column two edits describe 'bundled' procedures. The column 1 code generally represents the comprehensive service, and the column two code is the component that's part of the more extensive column one procedure, according to Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, consultant with MJH Consulting in Denver.
All of these edits carry a modifier indicator of "1", meaning you can use a modifier (like 59, distinct procedural service) to separate them - however ensure your documentation supports the modifier.
In addition, with effect from April 1, you should do the opposite and bundle 0193T into the following services:
51845 - Abdomino-vaginal vesical neck suspension,with or minus endoscopic control (example Stamey, Raz, modified Pereyra)
51990 - Laparoscopy, surgical; urethral suspension for stress incontinence
51992 -... sling operation for stress incontinence (example fascia or synthetic)
57160 - Fitting and insertion of pessary or otherintravaginal support device
57288 - Sling operation for stress incontinence (example., fascia or synthetic). Correct Coding Initiative (CCI) describes these bundles as "misuse of column two code" (which is 0193T) "with column one code." What's more, all of these edits carry a modifier indicator of "1," meaning you can use a modifier to segregate it - but see to it that your documentation supports the modifier, or you will face a denial.
Take note of just-in fluoroscopy bundle with Interstim Procedure
If your ob-gyn tests electrodes for the Interstim procedure, you are most likely used to reporting 64561 (Percutaneous implantation of neurostimulator electrodes; sacral nerve [transforaminal placement]).
What you may not be used to is including fluoroscopy codes (76000-76001, Fluoroscopy...; 77002-77003, Fluoroscopic guidance...). Correct Coding Initiative 16.1 tacks these codes as column 2 codes with a modifier "1" indicator, which means you will have to append and justify a modifier onto the fluoroscopy code to report both the procedures separately.
Do not let CCI version 16.1's lack of ob-gyn mutually exclusive edits put you into a false sense of security. Here is what you need to know to put off a denial from landing on your desk.
Payers like Noridian Part B will cover the female stress urinary incontinence treatment code 0193T, however, before you submit a 0193T claim, you will have to check with the CCI version 16.1's edits. For example, as of April 1, the work represented by 0193T will include that of cystourethroscopy codes [http://codingnews.inhealthcare.com/hot-coding-topics/ob-gyn-coding-clue-in-to-these-cci-edits-before-you-choose-0193t/] 52000-52001 and 52281.
Look for 0193T in Column 1, Column 2 Position
Last year, CPT added 0193T (Transurethral, radiofrequency micro-remodeling of the female bladder neck and proximal urethra for stress urinary incontinence) to your likely stress urinary incontinence (SUI) treatment coding options. This code covers the Renessa transurethral collagen radiofrequency denaturation procedure. Ob-gyns normally carry out this nonsurgical, minimally invasive alternative for women who have failed other nonsurgical treatments or who are not good candidates for surgery.
What happens: The ob-gyn makes use of controlled heat at low temperatures and aims at tissue in the woman's lower urinary tract. The heat alters the structure of the patient's natural tissue collagen. This aids the firmness of tissue and improves her continence. Even though the ob-gyn may use heat on multiple sites and document multiple cycles, you should go for 0193T to represent all the treatment cycles carried out during an encounter.
With effect from April 1, 0193T will cover the work represented by 52000-52001 (Cystourethroscopy ...) and 52281 (Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or minus meatotomy, with or minus injection procedure for cystography, male or female).
Reaction: These edits do not surprise me at all because 0193T says 'transurethral' which implies the use of the scope," according to Jan Rasmussen, CPC, AGS-GI, ACS-OB, president of Professional Coding Solutions in Eau Claire, Wis. For example, you should always cover "inserting the scope (52000) into the main procedure." As for 55231, "that's a little less obvious,"however CCI probably bundled that as these services may be part of the approach," adds Ramussen.
You should also cover 53660-53666 (Dilation of female urethra...) and 90901 (Biofeedback training by any modality). Correct Coding Initiative describes these edits as "misuse of column two code with column one code (0193T).
Keep in mind: Column one/ column two edits describe 'bundled' procedures. The column 1 code generally represents the comprehensive service, and the column two code is the component that's part of the more extensive column one procedure, according to Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, consultant with MJH Consulting in Denver.
All of these edits carry a modifier indicator of "1", meaning you can use a modifier (like 59, distinct procedural service) to separate them - however ensure your documentation supports the modifier.
In addition, with effect from April 1, you should do the opposite and bundle 0193T into the following services:
Take note of just-in fluoroscopy bundle with Interstim Procedure
If your ob-gyn tests electrodes for the Interstim procedure, you are most likely used to reporting 64561 (Percutaneous implantation of neurostimulator electrodes; sacral nerve [transforaminal placement]).
What you may not be used to is including fluoroscopy codes (76000-76001, Fluoroscopy...; 77002-77003, Fluoroscopic guidance...). Correct Coding Initiative 16.1 tacks these codes as column 2 codes with a modifier "1" indicator, which means you will have to append and justify a modifier onto the fluoroscopy code to report both the procedures separately.
