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The Coding Institute, Coding Tips: We’ve talked about a number of National Correct Coding Initiative (NCCI) version 22.1 edits, but somehow we’ve neglected the gyn area. Let’s check out some ob-gyn edits that have come into effect since Jan. 1.
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The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
Review NCCI Effects on Ob-Gyn By Susan Dooley
We’ve talked about a number of National Correct Coding Initiative (NCCI) version 22.1 edits, but
somehow we’ve neglected the gyn area. Let’s check out some ob-gyn edits that have come into effect
since Jan. 1.
Bundle Up Your Paravertebral Blocks
Let’s take a look at version 22.0 first. When you report 56405 (Incision and drainage of vulva or perineal
abscess), don’t 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,
With the paravertebral block codes, the bundles carry a “0” modifier indicator, which means you can’t
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 we’re talking about ob-gyn coding right now, let’s
concede that it’s pretty unlikely that an ob-gyn specialist would be placing a catheter into someone’s
skull to administer drugs. For that reason, ob-gyn coders don’t 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 payer’s 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,
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Contact Us:
Name: Sam Nair
Title: Associate Director
Email: [email protected]
Direct: 704 303 8150
The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713
