Practicing gynecologists need to be aware of several changes to ultrasound CPT codes and related ICD-10 codes that went into effect this year. Most notably, the Centers for Medicare and Medicaid Services (CMS) introduced a new reporting requirement for the CPT code 99024, the billing code for post-operative visits. CMS began global surgery data collection on July 1, 2017, for affected practitioners to begin reporting post-operative visits under this code. The new global surgery data reporting applies to a specific set of CPT codes for procedures performed by gynecologists in certain areas.
Who Is Affected by the New Reporting Requirement?
According to the CMS' surgery data collection guide, the changes apply to practitioners in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island. Any medical practice that employs 10 or more practitioners must adhere to the reporting requirement — that includes physicians and nonphysician practitioners (NPPs). It is important to note that that employees who fall into this category do not need to be located under the same roof.
If your gynecology practice is affected by these changes, you should consider the following questions:
- Are employees trained on the new requirements?
- Does your computer software support the new codes to report accurately, or does it need to be updated?
- Do your ultrasound systems communicate efficiently with your medical records, or do they need to be updated?
- Are you storing electronic copies of 3D ultrasound scans appropriately, so that your billing practices can withstand an audit?
- How can you be prepared in the event that this reporting is required of all gynecologists, regardless of location?
In its public presentation, the CMS stated that only practices that meet the criteria described above are required to report. However, other practices are "encouraged" to do so. If a practice that is not required to report chooses to, it must report all procedures with these codes. It is also helpful to remember that private insurers often follow guidelines set by the CMS, so if the agency makes these changes mandatory for all gynecologists, the new ultrasound codes and billing procedures may change for other insurers as well.
Where To Find More Information About Ultrasound CPT Codes
To assist with the global surgery data collection, the CMS published a FAQ document that provides information such as:
- How practice size is calculated
- Who is considered a practitioner under the CMS standard and whether or not locum tenens practitioners are counted
- Whether the requirements apply to Medicare Advantage and VA patients
- How to report for inpatient versus outpatient post-operative care
- How to process claims
The American Medical Association (AMA), which creates and maintains the CPT code set, published a list of recommended coding resources to assist medical practices with the intricacies of coding their procedures. To assist gynecologists in particular, the American Congress of Obstetricians and Gynecologists (ACOG) provided guidance on the new CPT coding requirements, as well as a list of eight gynecologic procedure codes. The gynecologic billing codes pertain to procedures such as a laparoscopy, colporrhaphy, sling operation and the implantation of neurostimulator electrode array. However, ACOG recommended reviewing the CMS' entire list, since your practice may perform other procedures to which the new billing standard applies.
Maximize Your Reimbursement
With the right equipment, properly trained staff and compliant billing practices, a 3D ultrasound system can drive revenue for a gynecology practice. Knowing the correct CPT code for pelvic ultrasound and other procedures will ensure that your billing claims are processed in a timely manner and that you receive a maximum reimbursement.
