Review NCCI Effects on Ob-Gyn

By Susan Dooley

Weve talked about a number of National Correct Coding Initiative (NCCI) version 22.1 edits, but
somehow weve neglected the gyn area. Lets check out some ob-gyn edits that have come into effect
since Jan. 1.

Bundle Up Your Paravertebral Blocks

Lets take a look at version 22.0 first. When you report 56405 (Incision and drainage of vulva or perineal
abscess), dont even think about including paravertebral blocks. All 56xxx, 58xxx, and 59xxx codes
include paravertebral block, as well as one other code, as part of the work involved in the procedure.
Check these out:

61650, Endovascular intracranial prolonged administration of pharmacologic agent(s) other than

for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging
guidance; initial vascular territory
64461, Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes
imaging guidance, when performed)
64463, continuous infusion by catheter (includes imaging guidance, when performed).
The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

With the paravertebral block codes, the bundles carry a 0 modifier indicator, which means you cant
override the edit by appending any modifiers whatsoever. Code 61650, however, carries a modifier
indicator of 1, meaning you can use a modifier such as 59 (Distinct procedural service) if your
documentation supports such usage. However, since were talking about ob-gyn coding right now, lets
concede that its pretty unlikely that an ob-gyn specialist would be placing a catheter into someones
skull to administer drugs. For that reason, ob-gyn coders dont need to worry about unbundling 61650.

Report One Type of Fibroid Removal per Session

One of the NCCI version 22.1 edits that went into effect on April 1 bundled fibroid removal and
myomectomy with radiofrequency ablation.

In Column 1, we have the following:

58140-58145, Myomectomy, excision of fibroid tumor(s) of uterus, 1 to 4 intramural myoma(s)

with total weight of 250 g or less and/or removal of surface myomas
58146, Myomectomy, excision of fibroid tumor(s) of uterus, 5 or more intramural myomas
and/or intramural myomas with total weight greater than 250 g, abdominal approach
58545-58546, Laparoscopy, surgical, myomectomy, excision

In Column 2 for the above codes is the following category III code:

0404T, Transcervical uterine fibroid(s) ablation with ultrasound guidance, radiofrequency.

The edits for the above codes carry a modifier indicator of 1, meaning you can bypass the bundle with
a modifier. However, the documentation would have to show a combination of excision and secondary
use of radiofrequency, which is quite unlikely. Moreover, notice that the bundled code 0404T is a
Category III CPT code. Unbundling in this group could trigger a denial if the payers policy is to only pay
for Category I CPT codes.

Got Tips?
CCI edits seem to come fast and furious all year long. Got any tips for success? Let us know in the
comment box below.

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

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Contact Us:
Name: Sam Nair
Title: Associate Director
Email: shyamn@codinginstitute.com
Direct: 704 303 8150

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com