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Female Genital System. CPT® copyright 2012 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors.

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Presentation on theme: "Female Genital System. CPT® copyright 2012 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors."— Presentation transcript:

1 Female Genital System

2 CPT® copyright 2012 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT®, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT® is a registered trademark of the American Medical Association. CPT® Disclaimer 2

3 Female Genital System Describe the structures associated with the female reproductive system Use appropriate medical terminology to identify services and select codes Apply the ICD-9-CM guidelines for assigning codes and the special guidelines for coding complications of pregnancy, childbirth and the puerperium Select CPT® and HCPCS Level II codes to describe the services and procedures related to the female reproductive system Apply CPT® and HCPCS Level II modifiers when appropriate Objectives 3

4 Female Genital System External genitalia Mons pubis Labia (majora and minora) Hymen Bartholin’s glands Clitoris Urethra Anatomy 4

5 Female Genital System Internal Genitalia Vagina Uterus Cervix Fallopian tubes (“tubes” or oviducts) Ovaries Anatomy 5

6 Female Genital System Female Genitalia 6

7 Female Genital System Diseases of the Genitourinary System –580-629 Complications of Pregnancy, Childbirth, and the Puerperium –630-679 Neoplasms V Codes –V01-V89 ICD-9-CM 7

8 Female Genital System Category 580-629 Non-neoplastic Non-pregnant Related to… –Kidneys –Ureters –Bladder –Urethra –Breasts (610-612) Benign conditions (e.g., cysts) ICD-9-CM 8

9 Female Genital System Category 630-679 Have sequencing priority Report any condition that affects pregnancy (labor, delivery, post-partum) If pregnancy is incidental to condition treated, report V22.2 as secondary code –Must document that condition treated does not affect pregnancy Only for mother, not newborn ICD-9-CM 9

10 Female Genital System Routine outpatient prenatal visits w/o complication First pregnancy –V22.0 Subsequent pregnancy –V22.1 First-listed Dx Not to be used with other Ch 11 Codes ICD-9-CM 10

11 Female Genital System High-risk Pregnancy Code from category V23 First-listed diagnosis May be reported with other Chapter 11 codes ICD-9-CM 11

12 Female Genital System Encounter w/ pregnant patient, no delivery Principal diagnosis is the complication(s) prompting the encounter –Complications are sequenced first Report all conditions treated during the encounter Cesarean delivery Principal diagnosis is the condition responsible for patient’s admission to labor and delivery ICD-9-CM 12

13 Female Genital System Categories 630-633 Molar pregnancy Ectopic pregnancy –Pregnancy in other than uterine cavity 90% tubal pregnancy Categories 634-639 Miscarriage Medically-induced abortion ICD-9-CM 13

14 Female Genital System Category 640-649 Complications mainly related to pregnancy –Placenta previa, Hypertension, HIV, etc. Category 650-659 Normal delivery Other indications in pregnancy, labor, and delivery Category 660-679 Complications of labor, delivery and puerperium ICD-9-CM 14

15 Female Genital System Neoplasm (140-239) Benign Malignant Code by location –Female breast (174) –Genitourinary organs (179-184) Body of uterus Cervix Ovary Fallopian tubes ICD-9-CM 15

16 Female Genital System Surgery (56405-58999) Arranged by anatomy “outside to inside” –Terms used to describe external female genitalia Perineum Vulva Pudenda Introitus Consider terminology to determine procedure –-ectomy = removal –Hyster = uterus CPT® 16

17 Female Genital System Vulva (56405-56821) Vagina (57000-57426) 57022 –Only CPT® code related to obstetrical complications NOT in labor/delivery section Cervix Uteri (57452-57800) Os = opening of cervix CPT® 17

18 Female Genital System Corpus Uteri (58100-58579) –Fundus = (body) of uterus –Endometrium = glandular lining tissue –Myometrium = muscular wall of uterus Excision –Biopsy < Myomectomy < Hysterectomy D&C –Scraping out endometrial tissue CPT® 18

19 Female Genital System Endoscopy Inspection of cavity/hollow organ using a scope –Laparoscopy = examination of abdominal cavity Surgical Endoscopy Always Includes Diagnostic Endoscopy CPT® 19

20 Female Genital System Hysterectomy 58150-58294 not by scope 58541-58554, 58570-58579 by scope Total –Removal of fundus + cervix (e.g., 58150) –TAH = removed through abdomen –TVH = removed through vagina Partial –Removal of fundus (cervix remains) (e.g., 58180) –LSH (Laparoscopic supracervical) CPT® 20

21 Female Genital System Hysteroscopy (58555-58565, 58579) Endoscopy of uterine cavity Oviduct/Ovary (58600-58770) Tubal ligation Ovary (58600-58960) CPT® 21

22 Female Genital System Antepartum care (59000-59076) Initial visit during pregnancy Ongoing visits during pregnancy –Average of 13 visits (global OB package) OB package includes… –Antenatal care –Delivery –Episiotomy and repair –Postpartum care Maternity Care/Delivery 22

23 Female Genital System Postpartum care includes… Hospital visits Six-week checkup in the office Services related to cesarean delivery –eg, two week incision check Unrelated encounters are reported separately Maternity Care/Delivery 23

24 Female Genital System “Partial” maternity/delivery care 59409-59430 –Patient moves –Change of coverage, etc. Cesarean Delivery (59510-59525) –“Cesarean on demand” Dx 669.7x Delivery After Previous Cesarean Delivery (59610-59622) –Successful vaginal delivery after cesarean (59610-59614) –Unsuccessful vaginal delivery after cesarean (59618-59622) Maternity Care/Delivery 24

25 Female Genital System Twin delivery Some payers may not reimburse extra Additional documentation may be necessary Vaginal delivery –59400 and 59409-51 –59610 and 59612-51 (If had a previous cesarean delivery) Cesarean –59610 or 59618 One vaginal/one Cesarean –59510 and 59409-51 –59618 and 59612-51 (If had a previous cesarean delivery) Maternity Care/Delivery 25

26 Female Genital System NOT included in OB global package –Some payers may include one ultrasound in global package (standard of care) More than one ultrasound may be performed 76815 Ultrasound 26

27 Female Genital System Spontaneous –Miscarriage Complete Incomplete –D&C (59812) may be required Induced (59840-59857) –Therapeutic (medical termination of pregnancy) Failed induced abortion –Hysterotomy 59857 Abortion 27

28 Female Genital System Multifetal pregnancy reduction (MPR) 59866 Hydatidiform mole No fetus/overgrowth of placental tissue 59870 (D&C) Removal of cerclage suture (59871) –Other than local anesthesia –Suture is removed for delivery Maternity Care/Other 28

29 Female Genital System Placement of needles/catheters into pelvic organs/genitalia (not prostate) for interstitial radioelement application 55920 Intersex Surgery Male to female 55970 Female to male 55980 Reproductive System Surgery 29

30 Female Genital System Genetics counseling 96040 –Time based (face-to-face) –Group counseling Non-physician 98961-98962 Physician 99401-99412 Vaccines –Administration (90460-90474) –Drug supply –Modifier 25 for separate/significant E/M CPT®/Medicine Section 30

31 Female Genital System Drug supply –e.g., J Codes Medicare Breast and Pelvic Exam –G0101 7 of 11 elements (minimum) must be documented HCPCS Level II 31

32 Female Genital System Standard modifiers apply –e.g. surgical modifiers 22, 58, 59, 78, etc. Modifier 25 –Significant/separate E/M on same day as a minor procedure Not required for separate services during OB global period Distinguish from 57 for E/M with major (90-day global) procedure Modifiers 32

33 Female Genital System The End

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