2019 ob/gyn surgery medicare reimbursement …2019 ob/gyn surgery medicare reimbursement coding...

2019 OB/GYN SURGERY MEDICARE REIMBURSEMENT CODING GUIDEEffective January 1, 2019

CPT CODE1/HCPCSCODE2

CODE DESCRIPTION

PHYSICIAN3 HOSPITAL OUTPATIENT4 ASC5

MEDICARE NAT’L AVGAPC AND APC DESCRIPTION

MEDICARE NAT’L AVG

MEDICARE NAT’L AVGFACILITY

SETTING

HYSTERECTOMY

58150Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s);

$1,049Inpatient only, not reimbursed for hospital outpatient or ASC

58152

Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (eg, Marshall-Marchetti-Krantz, Burch)


58180Supracervical abdominal hysterectomy (subtotal hysterectomy), with or without removal of tube(s), with or without removal of ovary(s)

$987Inpatient only, not reimbursed for hospital outpatient or ASC

58200

Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube(s), with or without removal of ovary(s)


58210

Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tube(s), with or without removal of ovary(s)


58240

Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof


58260 Vaginal hysterectomy, for uterus 250 g or less; $8465415, Level 5 Gynecologic Procedures

$4,126N/A for ASC

58262Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s)

$9415415, Level 5 Gynecologic Procedures

$4,126N/A for ASC

58263Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele

$1,0115415, Level 5 Gynecologic Procedures

$4,112N/A for ASC

Medicare National Average Rates and Allowables(Not Adjusted for Geography)


CODE DESCRIPTION





FACILITY SETTING

HYSTERECTOMY (CONT’D)

58270Vaginal hysterectomy, for uterus 250 g or less; with repair of enterocele


$4,126N/A for ASC

58275 Vaginal hysterectomy, with total or partial vaginectomy; $1,006Inpatient only, not reimbursed for hospital outpatient or ASC

58280Vaginal hysterectomy, with total or partial vaginectomy; with repair of enterocele


58285 Vaginal hysterectomy, radical (Schauta type operation) $1,509Inpatient only, not reimbursed for hospital outpatient or ASC

58290 Vaginal hysterectomy, for uterus greater than 250 g; $1,1745416, Level 6 Gynecologic Procedures

$6,344N/A for ASC

58291Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)


$4,126N/A for ASC

58292Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s), with repair of enterocele


$6,344N/A for ASC

58293Vaginal hysterectomy, for uterus greater than 250 g; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control


58294Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele


$4,126N/A for ASC

58541Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less;

$7335361, Level 1 Laparoscopy

$4,596 $2,130

58542Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)


$7,742 $3,428

58543Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g;


$7,742N/A for ASC

58544Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)


$7,742N/A for ASC

58548

Laparoscopy, surgical, with radical hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with removal of tube(s) and ovary(s), if performed


58550Laparoscopy surgical, with vaginal hysterectomy, for uterus 250 g or less;


$4,596 $2,130

58552Laparoscopy surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)

$1,0115362, Level 2 Laparoscopy

$7,742 $3,428

58553Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g;


$7,742N/A for ASC

58554Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)


$7,742N/A for ASC

58570Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less;


$7,742 $3,428

58571Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)


$7,595 $3,368


CODE DESCRIPTION





FACILITY SETTING

58572Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g;


$7,742N/A for ASC

58573Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)


$7,742N/A for ASC

MYOMECTOMY

58545Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight of 250 g or less and/or removal of surface myomas


$4.596 $2,130

58546Laparoscopy, surgical, myomectomy, excision; 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 g


$7,742 $3,428

OOPHORECTOMY

58920 Wedge resection or bisection of ovary, unilateral or bilateral $7165416, Level 6 Gynecologic Procedures

$6,344N/A for ASC

58940 Oophorectomy, partial or total, unilateral or bilateral; $552Inpatient only, not reimbursed for hospital outpatient or ASC

58943

Oophorectomy, partial or total, unilateral or bilateral; for ovarian, tubal or primary peritoneal malignancy, with para-aortic and pelvic lymph node biopsies, peritoneal washings, peritoneal biopsies, diaphragmatic assessments, with or without salpingectomy(s), with or without omentectomy


58953Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking;


58954Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking; with pelvic lymphadenectomy and limited para-aortic lymphadenectomy


58956Bilateral salpingo-oophorectomy with total omentectomy, total abdominal hysterectomy for malignancy


TUBAL LIGATION

58600Ligation or transection of fallopian tube(s), abdominal or vaginal approach, unilateral or bilateral


$2,361 $1,157

58605Ligation or transection of fallopian tube(s), abdominal or vaginal approach, postpartum, unilateral or bilateral, during same hospitalization (separate procedure)


58611

Ligation or transection of fallopian tube(s) when done at the time of cesarean delivery or intra-abdominal surgery (not a separate procedure) (List separately in addition to code for primary procedure)


58615Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach


$2,361 $1,157

58670Laparoscopy, surgical; with fulguration of oviducts (with or without transection)


$4,596 $2,130

58671Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or Falope ring)


$4,596 $2,130

ROBOTIC ASSISTANCE6

S29006 Surgical techniques requiring use of robotic surgical system(list separately in addition to code for primary procedure)

N/A

1. CPT copyright 2019 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

2. Centers for Medicare and Medicaid Services. Healthcare Common Procedure Coding System. http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS.html.

3. Centers for Medicare & Medicaid Services. Medicare Program; Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Final Rule, Federal Register (83 Fed. Reg. No. 226 59452-60303) 42 CFR Parts 405, 410, 411, 414, 415, 425, and 495. (https://www.federalregister.gov/documents/2018/11/23/2018-24170/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other-revisions. Published November 23, 2018. See also the January 2019 release of the PFS Relative Value File RVU19A at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files-Items/RVU19A.html. Final payment to the physician is adjusted by the Geographic Practice Cost Indices (GPCI). Also note that any applicable coinsurance, deductible, and other amounts that are patient obligations are included in the payment amount shown.

4. Centers for Medicare & Medicaid Services. Medicare Program: Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs. Final Rule, Federal Register (83 Fed. Reg. No. 225 58818-59179) 42 CFR Parts 416 and 419. https://www.gpo.gov/ fdsys/pkg/FR-2018-11-21/pdf/2018-24243.pdf. See also Medicare Program: Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Correction https://www.federalregister.gov/documents/2018/12/28/2018-28348/medicare-program-changes-to-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center Published December 28, 2018. Addendum B and Addendum AA

5. Centers for Medicare & Medicaid Services. Medicare Program: Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs. Final Rule, Federal Register (83 Fed. Reg. No. 225 58818-59179) 42 CFR Parts 416 and 419. https://www.gpo.gov/ fdsys/pkg/FR-2018-11-21/pdf/2018-24243.pdf. See also Medicare Program: Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Correction https://www.federalregister.gov/documents/2018/12/28/2018-28348/medicare-program-changes-to-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center Published December 28, 2018. Addendum AA, BB

6. HCPCS II S-codes cannot be reported to Medicare. They are used only by non-Medicare payers, which cover and price them according to their own requirements.

HOSPITAL INPATIENT PROCEDURE CODING FOR OB/GYN SURGERY

ICD-10-PCS procedure codes1 are used by hospitals to report surgeries and procedures performed in the inpatient setting.

All ICD-10-PCS codes have seven digits, each digit representing a specific character associated with procedures. Code assignment in ICD-10-PCS is a process of “constructing” the code by selecting values from a code table for each of the seven standard characters. Key characters are discussed below.

CHARACTER DESCRIPTION

3: Root Operation

The two main root operations for removal of tissue are B-Excision and T-Resection. By definition, B-Excision involves removing a portion of the body part and T-Resection involves removing the entire body part.2

For tubal ligation ie. sterilization, the root operation depends on the technique: 3

B-Excision is used for removal of a ”knuckle” of the fallopian tube 5-Destruction is used for fulguration and cautery L-Occlusion is used for ligation and division as well as for placement of devices such as rings and clips

Note that physicians may use these terms more broadly. It is the coder’s responsibility to determine what the physician’s documentation equates to in terms of ICD-10-PCS definitions. The physician is not expected to document using ICD-10-PCS code descriptions.4

4: Body Part

Because each body part is identified distinctly, separate codes are assigned for uterus (ie. corpus), cervix, ovary, and fallopian tube. This means that many common OB/GYN surgeries require two or more codes.

For example, ICD-10-PCS requires that two codes be assigned for a total hysterectomy: one removing the uterus and one code for removing the cervix.5 Similarly, for a total hysterectomy with bilateral salpingo-oophorectomy, four codes must be assigned: one each for removing the uterus, cervix, the ovaries and the fallopian tubes.

5: Approach

Different codes are constructed depending on the approach:

0-Open involves an open incision to directly expose the surgical site4-Percutaneous Endoscopic is used for procedures performed via laparoscopy7-Via Natural or Artificial Opening, eg. vaginal hysterectomyF-Via Natural or Artificial Opening With Percutaneous Endoscopic Assistance, eg, laparoscopically assisted vaginal hysterectomy

ICD-10-PCS PROCEDURE CODE PROCEDURE CODE DESCRIPTION

HYSTERECTOMY

Additional codes are assigned for removal of ovaries and fallopian tubes.

> SUPRACERVICAL OR SUBTOTAL HYSTERECTOMY (EXCISION OF UTERUS WITHOUT CERVIX)5,6

0UT90ZZ Resection of uterus, open approach

0UT94ZZ Resection of uterus, percutaneous endoscopic approach

> TOTAL ABDOMINAL HYSTERECTOMY, OPEN (TAH)7

0UT90ZZ Resection of uterus, open approach

plus

0UTC0ZZ Resection of cervix, open approach

> TOTAL HYSTERECTOMY, LAPAROSCOPIC (LVH)5

0UT94ZZ Resection of uterus, percutaneous endoscopic approach

plus

0UTC4ZZ Resection of cervix, percutaneous endoscopic approach

> TOTAL VAGINAL HYSTERECTOMY (TVH)7

0UT97ZZ Resection of uterus, via natural or artificial opening

plus

0UTC7ZZ Resection of cervix, via natural or artificial opening

> LAPAROSCOPICALLY ASSISTED VAGINAL HYSTERECTOMY (LAVH)8

0UT9FZZ Resection of uterus, via natural or artificial opening with percutaneous endoscopic assistance

plus

0UTC7ZZ Resection of cervix, via natural or artificial opening

> RADICAL HYSTERECTOMY

Radical hysterectomy involves removal of the uterus, cervix, ovaries and fallopian tubes as well as removal of uterine supporting structures (eg, ligaments), removal of the vagina, and/or extensive pelvic and aortic lymphadenectomy. Hysterectomy is coded as above. Additional codes are then assigned to capture removal of uterine supporting structures and vagina, and lymphadenectomy as performed.

MYOMECTOMY

0UB90ZZ Excision of uterus, open approach

0UB94ZZ Excision of uterus, percutaneous endoscopic approach

OOPHORECTOMY AND SALPINGECTOMY

> EXCISION OF OVARIAN LESION, WEDGE RESECTION

0UB00ZZ Excision of right ovary, open approach

0UB04ZZ Excision of right ovary, percutaneous endoscopic approach

0UB10ZZ Excision of left ovary, open approach

0UB14ZZ Excision of left ovary, percutaneous endoscopic approach

0UB20ZZ Excision of bilateral ovaries, open approach

0UB24ZZ Excision of bilateral ovaries, percutaneous endoscopic approach

> COMPLETE OOPHORECTOMY

0UT00ZZ Resection of right ovary, open approach

0UT04ZZ Resection of right ovary, percutaneous endoscopic approach

0UT10ZZ Resection of left ovary, open approach

0UT14ZZ Resection of left ovary, percutaneous endoscopic approach

0UT20ZZ Resection of bilateral ovaries, open approach

Notes:

1. ICD-10-CM: Department of Health and Human Services, Centers for Medicare & Medicaid Services. International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS). https://www.cms.gov/Medicare/Coding/ICD10/2019-ICD-10-PCS.html

2. CMS ICD-10-PCS Reference Manual 2016, p.38-40. See also ICD-10-PCS Procedure Coding System (ICD-10-PCS) 2016 Tables and Index, ICD-10-PCS Definitions appendix (0 3: Medical and Surgical - Operation), root operations Excision and Resection

3. AHA ICD-10-CM and ICD-10-PCS Coding Handbook with Answers 2016, p.338-339

4. 2016 ICD-10-PCS Official Guidelines for Coding and Reporting (Procedure), A11

5. AHA ICD-10-CM and ICD-10-PCS Coding Handbook with Answers 2016, p.273-274

6. Without an accompanying code for removing the cervix, a code for removing the uterus reflects only a subtotal hysterectomy.

7. AHA ICD-10-CM and ICD-10-PCS Coding Handbook with Answers 2016, p.280

8. AHIIMA ICD-10-PCS: An Allied Approach 2015, p.435-436, case study 10. Approach 7-Via Natural or Artificial Opening is used for removal of the cervix because the cervical portion of the procedure does not involve the laparoscope.

9. Codes for robotic assistance are assigned separately in addition to the primary procedure code.

ICD-10-PCS PROCEDURE CODE PROCEDURE CODE DESCRIPTION

0UT24ZZ Resection of bilateral ovaries, percutaneous endoscopic approach

> COMPLETE SALPINGECTOMY

0UT50ZZ Resection of right fallopian tube, open approach

0UT54ZZ Resection of right fallopian tube, percutaneous endoscopic approach

0UT60ZZ Resection of left fallopian tube, open approach

0UT64ZZ Resection of left fallopian tube, percutaneous endoscopic approach

0UT70ZZ Resection of bilateral fallopian tubes, open approach

0UT74ZZ Resection of bilateral fallopian tubes, percutaneous endoscopic approach

TUBAL LIGATION

0U570ZZ Destruction of bilateral fallopian tubes, open approach

0U574ZZ Destruction of bilateral fallopian tubes, percutaneous endoscopic approach

0UB70ZZ Excision of bilateral fallopian tubes, open approach

0UB74ZZ Excision of bilateral fallopian tubes, percutaneous endoscopic approach

0UL70ZZ Occlusion of bilateral fallopian tubes, open approach

0UL74ZZ Occlusion of bilateral fallopian tubes, percutaneous endoscopic approach

ROBOTIC ASSISTANCE9

8E0W0CZ Robotic assisted procedure of trunk region, open approach

8E0W4CZ Robotic assisted procedure of trunk region, percutaneous endoscopic approach

HOSPITAL INPATIENT DRGS FOR OB/GYN SURGERYDRG Assignment FY 2019—effective October 1, 2018

Under Medicare’s MS-DRG methodology for hospital inpatient payment, each inpatient stay is assigned to one of about 750 diagnosis-related groups, based on the ICD-10 codes assigned to the diagnoses and procedures. Each MS-DRG has a relative weight that is then converted to a flat payment amount. Implanted devices are typically included in the flat payment and are not paid separately. Only one MS-DRG is assigned for each inpatient stay, regardless of the number of procedures performed. MS-DRGs shown are those typically assigned to the following scenarios when the patient is admitted specifically for the procedure.

MS-DRG1 MS-DRG TITLE1,2

FY 2019 RELATIVE WEIGHT1

FY 2019 GEOMETRIC MEAN LENGTH OF STAY1

FY 2019 SUBJECT TO

PACT1,3

FY 2019 MEDICARE NATIONAL AVERAGE4

HYSTERECTOMY5

734Pelvic Evisceration, Radical Hysterectomy and Radical Vulvectomy W CC/MCC

2.3059 3.7 No $14079

735Pelvic Evisceration, Radical Hysterectomy and Radical Vulvectomy W/O CC/MCC

1.3650 1.8 No $8,334

736Uterine and Adnexa Procedures for Ovarian or Adnexal Malignancy W MCC

4.0306 8.9 No $24,609

737Uterine and Adnexa Procedures for Ovarian or Adnexal Malignancy W CC

2.0314 4.6 No $12,402

738Uterine and Adnexa Procedures for Ovarian or Adnexal Malignancy W/O CC/MCC

1.3923 2.8 No $8,501

739Uterine, Adnexa Procedures for Non-Ovarian/Adnexal Malignancy W MCC

3.5977 6.6 No $21,966

740Uterine, Adnexa Procedures for Non-Ovarian/Adnexal Malignancy W CC

1.7429 3.0 No $10,641

741Uterine, Adnexa Procedures for Non-Ovarian/Adnexal Malignancy W/O CC/MCC

1.3278 1.7 No $8,107

742Uterine and Adnexa Procedures for Non-Malignancy W CC/MCC

1.7140 3.0 No $10,465

743Uterine and Adnexa Procedures for Non-Malignancy W/O CC/MCC

1.1156 1.8 No $6,811

MYOMECTOMY6


1.7140 3.0 No $10,465


1.1156 1.8 No $6,811

OOPHORECTOMY AND SALPINGECTOMY

736Uterine and Adnexa Procedures for Ovarian or Adnexal Malignancy W MCC

4.0306 8.9 No $24,609

737Uterine and Adnexa Procedures for Ovarian or Adnexal Malignancy W CC

2.0314 4.6 No $12,402

738Uterine and Adnexa Procedures for Ovarian or Adnexal Malignancy W/O CC/MCC

1.3923 2.8 No $8,501

739Uterine, Adnexa Procedures for Non-Ovarian/Adnexal Malignancy W MCC

3.5977 6.6 No $21,966

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REFERENCES:

1. Centers for Medicare & Medicaid Services. Medicare Program: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2019 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs (Promoting Interoperability Programs) Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals; Medicare Cost Reporting Requirements; and Physician Certification and Recertification of Claims. Final Rule, Federal Register (83 Fed. Reg. No. 160 41144-417842) 42 CFR Parts 412, 413, 424, and 495 https://www.gpo.gov/fdsys/pkg/FR-2018-08-17/pdf/2018-16766.pdf. Published August 17, 2018.

2. W MCC in MS-DRG titles refers to secondary diagnosis codes that are designated as major complications or comorbidities. MS-DRGs W MCC have at least one major secondary complication or comorbidity. Similarly, W CC in MS-DRG titles refers to secondary diagnosis codes designated as other (non-major) complications or comorbidities, and MS-DRGs W CC have at least one other (non-major) secondary complication or comorbidity. MS-DRGs WO CC/MCCs have no secondary diagnoses that are designated as complications or comorbidities, major or otherwise. Note that some secondary diagnoses are only designated as CCs or MCCs when the conditions were present on admission, and do not count as CCs or MCCs when the conditions are acquired in the hospital during the stay.

3. Post-Acute Care Transfer (PACT) status refers to selected DRGs in which payment to the hospital may be reduced when the patient is discharged by being transferred out. The DRGs impacted are those marked “Yes” and the patient must be transferred out before the geometric mean length of stay to certain post-acute care providers, including rehabilitation hospitals, long term care hospitals, skilled nursing facilities, or to home under the care of a home health agency. When these conditions are met, the DRG payment is converted to a per diem and payment is made as double the per diem rate for the first day plus the per diem rate for each remaining day up to the full DRG payment.

4. Payment is based on the average standardized operating amount ($5646.08) plus the capital standard amount ($459.41). The payment rate shown is the standardized amounts for facilities with a wage index greater than one. The average standard amounts shown also assume facilities receive the full quality update. The payment will also be adjusted by the Wage Index for specific geographic locality. Therefore, payment for a specific hospital will vary from the stated Medicare national average payment levels shown. Also note that any applicable coinsurance, deductible, and other amounts that are patient obligations are included in the national average payment amount shown.

5. DRGs 734, 735 for Radical Hysterectomy require the presence of additional codes for removal of uterine supporting structures (eg, ligaments) and/or extensive pelvic and aortic lymphadenectomy.

6. Myomectomy is typically performed for non-malignant lesions, eg, fibroids.

MS-DRG1 MS-DRG TITLE1,2

FY 2019 RELATIVE WEIGHT1

FY 2019 GEOMETRIC MEAN LENGTH OF STAY1

FY 2019 SUBJECT TO

PACT1,3

FY 2019 MEDICARE NATIONAL AVERAGE4

740Uterine, Adnexa Procedures for Non-Ovarian/Adnexal Malignancy W CC

1.7429 3.0 No $10,641

741Uterine, Adnexa Procedures for Non-Ovarian/Adnexal Malignancy W/O CC/MCC

1.3278 1.7 No $8107


1.7140 3.0 No $10465


1.1156 1.8 No $6.811

TUBAL LIGATION

744D&C, Conization, Laparoscopy and Tubal Interruption W CC/MCC

1.6903 4.1 No $10,320

745D&C, Conization, Laparoscopy and Tubal Interruption W/O CC/MCC

1.0694 2.1 No $6,529

Medtronic provides this information for your convenience only. It does not constitute legal advice or a recommendation regarding clinical practice.Information provided is gathered from third-party sources and is subject to change without notice due to frequently changing laws, rules and regulations. The provider has the responsibility to determine medical necessity and to submit appropriate codes and charges for care provided. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other payers as to the correct form of billing or the amount that will be paid to providers of service. Please contact your Medicare contractor, other payers, reimbursement specialists and/or legal counsel for interpretation of coding, coverage and payment policies. This document provides assistance for FDA approved or cleared indications. Where reimbursement is sought for use of a product that may be inconsistent with, or not expressly specified in, the FDA cleared or approved labeling (e.g., instructions for use, operator’s manual or package insert), consult with your billing advisors or payers on handling such billing issues. Some payers may have policies that make it inappropriate to submit claims for such items or related service.

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2019 ob/gyn surgery medicare reimbursement …2019 ob/gyn surgery medicare reimbursement coding...

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