Gynecological Surgery physicians’ offices must have an in-depth knowledge of GYN surgical coding and billing guidance. Often gynecological coding involves the usage of “unlisted” codes for difficult or “outside the box” surgical techniques that do not have a current CPT® code. Correct coding knowledge, as well as documentation macros are useful for implementing better documentation into the medical and patient care records, and better documentation is essential for correct claims.
Understand what’s included in the Global Surgical Package
Services to include in the global surgical package depend on the payer of a particular claim. However, the global surgical package is defined in CPT® as including:
- Local infiltration, metacarpal/ metatarsal/ digital block or topical anesthesia
- One related E/M encounter on the date of the procedure (including history and physical) or one day before, once the decision for surgery is made
- Immediate postoperative care
- Writing orders
- Evaluating the patient in the post-anesthesia recovery area
- Typical postoperative follow-up care
On the other hand, CMS has its own Medicare surgical package, as it doesn’t follow Ob-Gyn CPT® coding guidelines. This includes:
- Pre-op visits for the day before surgery for 90 day global and day of surgery for 0-10 global
- Complication following the surgery
- Post-op visits (related to recovery from procedure)
- Post-surgical pain management provided by surgeon
- Supplies
- Miscellaneous services (dressing changes, staple, drain, tube removal, local incision care, etc.)
When contracting with private payers, find out whether they follow CPT or Medicare guidelines.
Use Modifiers and Unlisted Codes with Gynecological Surgery
Ob-Gyns often see patients with multiple conditions or problem reports. For patients within a global period, bill including modifiers to indicate special circumstances, as the absence of a modifier will result in the intervention being bundled into the global and you not being paid for it. The two-digit codes that are modifiers make a huge difference, as they provide critical information to payers. Modifiers indicate that a service or procedure has been altered by some specific circumstance, without changing the definition or code.
Modifiers 22, 57, 58, 78, 79 can all be used with GYN surgery coding. For example, Modifier 58 is defined as staged or related procedure or service by the same physician during postoperative care. On the other hand, Modifier 78 is defined as unplanned return to the operating / procedure room by the same physician following initial procedure for a related procedure during the postoperative period. Modifier 79 is defined as unrelated procedure or service by the same physician during the postoperative period.
With the use of Modifier 58, document the staged relationship to the original surgery in the medical record. However, there is no requirement to know the necessity or the date of the subsequent surgery on the day of the original surgery. Modifier 58’s definition includes the term anticipated to allow physicians to anticipate the potential for subsequent procedures without necessarily predicting it.
Modifiers are intended to communicate specific information about a certain service or procedure that is not already included in the code definition. Modifiers are not intended to be used to report services that are “similar” or “closely related” to a procedure code. In situations where no code or combination of codes or modifier(s) will accurately report the service performed, provide written documentation and use the unlisted code closest to the section which resembles the type of service provided to report the service.
For Ob-Gyn practices, knowledge of CPT®, ICD-10-CM and ACOG guidelines and documentation criteria is essential for compliant and correct coding and billing. For more information and insights on code revisions, deletions and addsitions and ob-gyn coding updates for 2017 and how to use the new codes, attend this Live Audio Conference by expert speaker Jan Rasmussen, PCS, ACS-GI, ACS-OB on Thursday, Dec 15, 2016.
Also, Jan will be sharing her OB-GYN coding knowledge at Coding Updates Virtual Bootcamp 2016, the year’s biggest virtual boot camp on coding updates for 2017.
