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    New 2010 CPT Codes: Ob-gyns
    By ACOG: American Congress of Obstetricians and Gynecologists - Posted on 30 December 2010

    The Current Procedural Terminology (CPT) code set for 2010 includes several changes of interest to ob-gyns, including guideline clarifications in addition to new, revised and deleted CPT codes. These changes take effect January 1. Because of the HIPAA requirements, insurers must accept new codes beginning January 1. ACOG’s Committee on Coding and Nomenclature proposed some of the CPT code changes to the American Medical Association CPT Editorial Panel, which approved them for 2010.

    Evaluation and Management (E/M) Services Guidelines: Concurrent Care and Transfer of Care

    The Concurrent E/M Services Guidelines have been revised to include “Transfer of Care”. Accordingly, CPT defines transfer of care as the process whereby a physician who is providing management for some or all of a patient’s problems relinquishes this responsibility to another physician who agrees to accept this responsibility and who from the initial encounter, is not providing consultative services. The guidelines also explain that the transferring physician is no longer responsible and that the consultation codes should not be reported by the physician who has accepted care. However, the consultation codes can be reported if the decision to accept transfer of care cannot be made until after the initial consultation evaluation.

    Evaluation and Management (E/M): Consultations

    To clarify the two circumstances under which consultations may be rendered, the Evaluation and Management (E/M) section subheading, “Consultations” has been revised. The circumstances are: 1) to provide opinion/services for a specific condition or problem, or 2) to allow a determination to be made on whether to accept the ongoing management of the patient’s entire care or for the care of a specific condition or problem (ie, transfer of care).

    CPT emphasized that documentation of the written or verbal request for a consultation can be done by either the consultant or by the requesting physician or other appropriate source.

    Another editorial change was made under the “Consultations” subheading to direct users to see the instructions in the Initial Hospital Inpatient Care and Initial Nursing Facility Care sections to determine how to code circumstances in which a patient is admitted to the hospital or nursing facility in the course of an office or other ambulatory facility visit. These circumstances are described in a new paragraph added to the introductory notes for “Inpatient Consultations”.

    Evaluation and Management (E/M): Prolonged Physician Service Without Direct (Face-To-Face) Patient Contact

    Guidelines have be revised to clarify that prolonged services without direct (face-to-face) patient contact codes are to be reported for prolonged services that are beyond the usual non-face-to-face component of the physician service time. Also, the add-on status has been removed from code 99358, which helps clarify that the prolonged services (99358 and 99359) may now be reported on a different date than the primary service to which it is related.

    However, the guidelines specify that the prolonged service must relate to a service or patient where direct face-to-face patient care has occurred or will occur and relate to ongoing patient management. The primary service to which the prolonged service is related does not need to have a typical time established in the CPT code set. Additional language states that 99358 should be used only once per date.

    The new guidelines make it clear that codes 99358 and 99359 should not be reported for time spent in medical team conferences, on-line medical evaluations, care plan oversight services, anticoagulation management, or other non face-to-face services that have more specific codes and no upper time limit in the CPT code set. However, when related to other non-face-to-face services that have a published maximum time (eg, telephone services), codes 99358, 99359 may be reported.

    With the removal of the add-on code status from 99358, the descriptors of codes 99358 and 99359 were revised with the deletion of the standard add-on code language. The examples of prolonged services were also removed from codes 99358 and 99359.

    99358 Prolonged evaluation and management service before and/or after direct (face-to-face) patient care; first hour

    +99359 each additional 30 minutes (List separately in addition to code for prolonged physician service)

    General Surgery

    A cross-reference has been added following code 10022 to direct coders to use code 19295 for the percutaneous placement of localization clip during breast biopsies. The changes are as follows:

    10021 Fine needle aspiration; without imaging guidance
    10022 with imaging guidance
    (For placement of percutaneous localization clip during breast biopsy, use 19295)

    Urodynamics

    The urodynamics section includes three news codes (51727, 51728, and 51729), two revised codes (51726, and 51797) and two deletions (51772 and 51795) to capture the combinations of services in these studies. Code 51726 is now a parent code that identifies the use of complex cystometrogram (i.e., calibrated electronic equipment) with 1) the urethral pressure profile studies which was previously identified by code 51772 and now identified by code 51727, or 2) with voiding pressure studies (ie, the bladder voiding pressure), previously identified by code 51795 but now identified by 51728), or 3) both voiding pressure studies and urethral pressure profile studies (recognized by code 51729). By indenting new codes 51727-51729 under code 51726, CPT is noting that these procedures are typically performed together. Further, code 51726 allows for the reporting of the complex cystometrogram as an independent service. Code 51797 has also been retained and revised to identify the specific intra-abdominal voiding pressure studies performed. CPT has placed parenthetic notes in this section to direct users to the appropriate codes to use and to identify the services that have replaced the deleted codes. The codes are as follows:

    The following section (51725-5179251797) lists procedures that may be used separately or in many and varied combinations.

    51726 Complex cystometrogram (egie, calibrated electronic equipment);
    51727 with urethral pressure profile studies (ie, urethral closure pressure profile), any technique
    51728 with voiding pressure studies (ie, bladder voiding pressure), any technique

    51729 with voiding pressure studies (ie, bladder voiding pressure) and urethral pressure profile studies (ie, urethral closure pressure profile), any technique
    (51772 has been deleted. To report urethral pressure profile studies, see 51727, 51729)
    (51795 has been deleted. To report bladder voiding pressure studies, see 51728, 51729)

    +51797 Voiding pressure studies, intra-abdominal voiding pressure (AP) (ie, rectal, gastric, intraperitoneal) (List separately in addition to code for primary procedure)

    (Use 51797 in conjunction with 51728, 51729

    Female Genital System (Vagina, Repair)
    Endoscopy/Laparoscopy

    The Endoscopy heading in the Vagina subsection has been revised to include “Laparoscopy”, since laparoscopic procedures are listed in this section. New code 57426 has been developed to describe the revision of a prosthetic vaginal graft using a laparoscopic approach which is widely performed. Prosthetic vaginal graft revision is necessary due to infection. The removal of a prosthetic vaginal graft is included in code 57426, when performed and should not be reported separately. A cross-reference note has been added to instruct users to codes 57295 and 57296 when a vaginal or open abdominal approach is used for this procedure.

    57426 Revision (including removal) of prosthetic vaginal graft, laparoscopic approach (For vaginal approach, see 57295. For open abdominal approach, see 57296)

    Maternity Care and Delivery

    The Maternity Care and Delivery/Antepartum Services subheading has been revised to include fetal invasive services to more accurately describe the procedures listed in this section. Also a new cross-reference note has been added following the subheading to direct users to code 36460 for fetal intrauterine transfusions. The cross-reference note following code 59076 has been relocated above code 59000, as this instruction does not apply solely to code 59076.

    Antepartum and Fetal Invasive Services

    (For fetal intrauterine transfusion, use 36460)
    (For unlisted fetal invasive procedure, use 59897)

    59000 Amniocentesis; diagnostic
    (For radiological supervision and interpretation, use 76946)
    59076 Fetal shunt placement, including ultrasound guidance
    (For unlisted fetal invasive procedure, use 59897)

    Other Procedures

    Code 59897 describes an unlisted fetal invasive procedure, which includes ultrasound guidance when performed. To clarify that code 59897 may be reported whether ultrasound guidance is used or not, the descriptor has been revised to indicate ultrasound guidance, when performed as follows:

    59897 Unlisted fetal invasive procedure, including ultrasound guidance, when performed

    Pathology and Laboratory: Organ or Disease-Oriented Panels

    The introductory language in the Organ or Disease-Oriented Panels subsection of the Pathology and Laboratory section was revised to clarify that users should not report multiple panel codes that include any of the same constituent analytes performed from the same patient collection. As such, it appropriate to report the most comprehensive panel and individual codes for the tests performed. In accordance with this change, the parenthetical notes following panel codes 80047, 80053, and 80076 were deleted. The term “analytes” was changed to “tests” in the guidelines and the phrase “(eg, do not report 80047 in conjunction with 80053)”was added at the end of the guidelines. All references to code 82310 found in the panel codes were corrected to state, “Calcium, total,” since this reflects the correct descriptor for this code. Further code 80055 includes a cross reference note to clarify that when syphilis screening is performed using a treponemal antibody approach [86780], code 80055 should not be assigned.

    80055 Obstetric panel

    (When syphilis screening is performed using a treponemal antibody approach [86780], do not use 80055. Use the individual codes for the tests performed in the obstetric panel)

    Reproductive Medicine Procedures

    Cryopreservation of Ovarian Reproductive Tissues
    In 2008 category III code 0058T (Cryopreservation, reproductive tissue, ovarian) was deleted from CPT. To assist coders with coding this service CPT has added a cross-reference following code 89335 directing users to assign 89240 (Unlisted miscellaneous pathology test) for the cryopreservation of ovarian reproductive tissues.

    Unlisted Reproductive Medicine Laboratory Procedure
    To allow users to report for unlisted reproductive medicine testing procedures a new code has been developed. The new codes states:

    89398 Unlisted reproductive medicine laboratory procedure

    Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration

    In order to clarify the relation of certain parenthetical instructions to the principal guidelines for the Hydration, Therapeutic, Prophylactic, Diagnostic Injections Infusions, and Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration subsection, the guidelines were revised to clarify that the hierarchy structure for infusions is sequential and does not pertain to the level of difficulty. The guidelines were further refined to clarify appropriate reporting of the hierarchy structure by facilities.

    H1N1

    In consultation with the U.S. Department of Health and Human Services, the AMA CPT Editorial Panel has revised CPT code 90663 (Influenza virus vaccine, pandemic formulation, H1N1) to refer specifically to the reporting of the H1N1 vaccine product. Further, they created new CPT code 90470 (H1N1 immunization administration (intramuscular, intranasal), including counseling when performed) to report for the H1N1 vaccine administration. Both codes became effective in September of 2009.

    The Centers for Medicare and Medicaid Services (CMS) created two new HCPCS codes for H1N1 vaccine and administration, that became effective September 1, 2009. The codes are as follows:

    Code for administration:
    G9141 – Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family)

    Code for vaccine product:
    G9142 - Influenza A (H1N1) vaccine, any route of administration

    The same billing rules apply to the H1N1 vaccine as apply to the seasonal influenza vaccine with one exception. Since the H1N1 vaccine is being made available at no cost to providers, Medicare will not pay providers for the vaccine. HCPCS code G9142 does not need to be placed on the claim when reporting for the vaccine administration.

    Questions and comments may be emailed to: coding@acog.org

     

    2010 CPT Code Changes

    Guidelines

    Evaluation & Management Services Guide (CMS-July 2009)
    1997 E/M Documentation Guidelines
    1995 E/M Documentation Guidelines
    E/M Pocket Guide (Trailblazer Health: 2008)

    History Documentation

    Documenting a History (Tulane University Medical Group)
    Highmark Medicare Services HPI Elements (Reviewed 05/13/08)

    FAQ

    Highmark Medicare Services FAQ (Reviewed 2/13/2008)
    Wisconsin Medical Society FAQ (2008)
    Medicare Physician Guide (CMS-July 2007)
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