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Know Ob-Gyn CPT Code Changes in 2017 to Optimize Reimbursement

by | Mar 23, 2017 | Medical Coding News, Resources | 0 comments

Ob-Gyn practices face many challenges relating to both practice and reimbursement. In addition to Meaningful Use and value-based reimbursement, 2017 has brought many changes in obstetrics and gynecology medical billing and coding. While medical billing and coding outsourcing can help providers take advantage of new reimbursement opportunities, it’s important that Ob-Gyns are well-informed about these updates.

Key CPT Codes Changes for Ob-Gyn in 2017

  • Removal of moderate sedation symbol for certain codes:
    Previously, a bull’s eye symbol indicated that the ob-gyn procedure includes the moderate sedation service. In 2017, this moderate sedation symbol has been removed for the following CPT codes:10030, Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst), soft tissue (eg, extremity, abdominal wall, neck), percutaneous
    49406, Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); peritoneal or retroperitoneal, percutaneous
    49407, …peritoneal or retroperitoneal, transvaginal or transrectal
    57155, Insertion of uterine tandem and/or vaginal ovoids for clinical brachytherapy
  • New codes for moderate sedation services based on who performs them:
    Codes 99144 and 99145 have been deleted. As moderate sedation has to reported separately, new codes have been assigned based on who provides the moderate sedation services.The codes for moderate sedation performed by the same surgeon who performed the procedure are:
    99156, Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient age 5 years or older
    99157, …each additional 15 minutes intraservice time (to be list separately in addition to code for the primary service)If the moderate sedation is performed by a provider who is not performing the procedure, either 99156 or 99157 should be reported. Codes 99149 and 99150 have been deleted.
    99156, Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient age 5 years or older
    99157, …each additional 15 minutes intraservice time (this code should be listed separately in addition to code for the primary service)
  • Addition of regular CPT code for Laparoscopic Ablation of Fibroids:
    CPT 2017 has introduced the following regular Category II code for laparoscopic ablation of fibroids:
    58674, Laparoscopy, surgical, ablation of uterine fibroids, including intraoperative ultrasound guidance and monitoring, radiofrequency
    0422T – Tactile breast imaging by computer-aided tactile sensors, unilateral or bilateral
    2013 Category III code 0336T, Laparoscopy, surgical, ablation of uterine fibroids, including intraoperative ultrasound guidance and monitoring, radiofrequency, has been deleted.
  • CAD (Computer-aided detection) and Mammogram codes combined:
    These two radiological images are no longer reported separately. As they are typically performed together, in 2017, the codes were merged to include CAD in imaging when it is performed. The new codes are:
    77065, Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral
    77066, Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral
    77067, Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed CPT codes 77051, 77052, 77055, 77056, and 77057 are no longer valid in 2017.
  • New Flu Codes:
    CPT 2017 provides new guidance on reporting flu with the focus on dosage of vaccine administered. Flu codes have been revised to remove any reference to the age of the patient:
    90655, Influenza virus vaccine, trivalent (IIV3), split virus, preservative free – when administered to children 6-35 months of age 0.25mL dosage, for intramuscular use
    90656, Influenza virus vaccine, trivalent (IIV3), split virus, preservative free – when administered to individuals 3 years and older 0.5mL dosage, for intramuscular use
    90661, Influenza virus vaccine, trivalent (IIV3), split virus, when administered to children 6-35 months of age 0.25mL dosage, for intramuscular use
    90658, Influenza virus vaccine, trivalent (IIV3), split virus, when administered to individuals 3 years and older 0.5mL dosage, for intramuscular use
    90661, Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage for intramuscular use
    90674, Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage for intramuscular use
    90685, Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free- when administered to children 6-35 months of age 0.25mL dosage, for intramuscular use
    90686, Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free – when administered to individuals 3 years and older 0.5mL dosage, for intramuscular use
    90687, Influenza virus vaccine, quadrivalent (IIV4), split virus, when administered to children 6-35 months of age 0.25mL dosage, for intramuscular use
    90688, Influenza virus vaccine, quadrivalent (IIV4), split virus, when administered to individuals 3 years and older 0.5mL dosage, for intramuscular use

Expert obstetrics and gynecology medical billing services are available to help Ob-Gyns stay current with the latest coding changes and report services correctly to avoid denials. Partnering with the right company will ensure timely and error-free submission of medical claims for optimal reimbursement.