Transcription
2022 Billing and Coding GuideGynecology SurgeryRates listed in this guide are based on their respective site of care- ambulatory surgical center or hospital outpatient department. Allrates provided are for the Medicare unadjusted national average rounded to the nearest whole number for the calendar year and donot represent adjustment specific to the provider's location or facility. Commercial rates are based on individual contracts. Providersare encouraged to review contracts to verify their specific contracted allowables.Medtronic products associated with wound closure procedures addressed within this guide do not have a dedicated HCPCS1 Level II codingassignment. Providers may choose to report A4649 Surgical supply; miscellaneous for purposes of cost tracking. Medicare considers the use ofsurgical supplies to be included in the payment for the associated CPT , and no additional payment is allowed.CPT al Center4Outpatient4Hysterectomy58150Total abdominal hysterectomy (corpus and cervix),Facility Only: 1,040Inpatient only, not reimbursed for hospitaloutpatient or ASCwith or without removal of tube(s), with or withoutremoval of ovary(s);58152Total abdominal hysterectomy (corpus and cervix),Facility Only: 1,275Inpatient only, not reimbursed for hospitaloutpatient or ASCwith or without removal of tube(s), with or withoutremoval of ovary(s); with colpo-urethrocystopexy (e.g.,Marshall- Marchetti-Krantz, Burch)58180Supracervical abdominal hysterectomy (subtotalFacility Only: 987Inpatient only, not reimbursed for hospitaloutpatient or ASChysterectomy), with or without removal of tube(s), withor without removal of ovary(s)58200Total abdominal hysterectomy, including partialFacility Only: 1,381Inpatient only, not reimbursed for hospitaloutpatient or ASCvaginectomy, with para-aortic and pelvic lymph nodesampling, with or without removal of tube(s), with orwithout removal of ovary(s)58210Radical abdominal hysterectomy, with bilateral totalFacility Only: 1,869Inpatient only, not reimbursed for hospitaloutpatient or ASCpelvic lymphadenectomy and para-aortic lymph nodesampling (biopsy), with or without removal of tube(s),with or without removal of ovary(s)58240Pelvic exenteration for gynecologic malignancy, withtotal abdominal hysterectomy or cervicectomy, with orwithout removal of tube(s), with or without removal ofovary(s), with removal of bladder and ureteraltransplantations, and/or abdominoperineal resection ofrectum and colon and colostomy, or any combination1 Facility Only: 3,018Inpatient only, not reimbursed for hospitaloutpatient or ASC
CPT CodeDescription23PhysicianAmbulatorySurgical CenterHospital4Outpatient4Hysterectomy Continued58260Vaginal hysterectomy, for uterus 250 g or less;Facility Only: 865 1,910 4,50358262Vaginal hysterectomy, for uterus 250 g or less; withFacility Only: 955 1,910 4,503Facility Only: 1,024N/A 4,503Facility Only: 924N/A 4,503Facility Only: 1,019Inpatient only, not reimbursed for hospitalremoval of tube(s), and/or ovary(s)58263Vaginal hysterectomy, for uterus 250 g or less; withremoval of tube(s), and/or ovary(s), with repair ofenterocele58270Vaginal hysterectomy, for uterus 250 g or less; withrepair of enterocele58275Vaginal hysterectomy, with total or partialoutpatient or ASCvaginectomy;58280Vaginal hysterectomy, with total or partialFacility Only: 1,093outpatient or ASCvaginectomy; with repair of enterocele58285Vaginal hysterectomy, radical (Schauta type operation)Inpatient only, not reimbursed for hospitalFacility Only: 1,459Inpatient only, not reimbursed for hospitaloutpatient or ASC58290Vaginal hysterectomy, for uterus greater than 250 g;Facility Only: 1,186N/A 6,93358291Vaginal hysterectomy, for uterus greater than 250 g;Facility Only: 1,282N/A 4,503Facility Only: 1,351N/A 6,933Facility Only: 1,255N/A 4,503Facility Only: 752 2,363 5,168Facility Only: 857 3,890 9,096Facility Only: 869 3,890 9,096Facility Only: 933 3,890 9,096Facility Only: 1,931Inpatient only, not reimbursed for hospitalwith removal of tube(s) and/or ovary(s)58292Vaginal hysterectomy, for uterus greater than 250 g;with removal of tube(s) and/or ovary(s), with repair ofenterocele58294Vaginal hysterectomy, for uterus greater than 250 g;with repair of enterocele58541Laparoscopy, surgical, supracervical hysterectomy, foruterus 250 g or less;58542Laparoscopy, surgical, supracervical hysterectomy, foruterus 250 g or less; with removal of tube(s) and/orovary(s)58543Laparoscopy, surgical, supracervical hysterectomy, foruterus greater than 250 g;58544Laparoscopy, surgical, supracervical hysterectomy, foruterus greater than 250 g; with removal of tube(s)and/or ovary(s)58548Laparoscopy, surgical, with radical hysterectomy, withoutpatient or ASCbilateral total pelvic lymphadenectomy and para-aorticlymph node sampling (biopsy), with removal of tube(s)and ovary(s), if performed58550Laparoscopy surgical, with vaginal hysterectomy, foruterus 250 g or less;2 Facility Only: 907 2,363 5,168
CPT Code58552Description2Laparoscopy surgical, with vaginal hysterectomy, for3PhysicianAmbulatorySurgical CenterHospital4Outpatient4Facility Only: 1,008 3,890 9,096Facility Only: 1,152 3,890 9,096Facility Only: 1,341 3,890 9,096 3,890 9,096 3,890 9,096 3,890 9,096 3,890 9,096uterus 250 g or less; with removal of tube(s) and/orovary(s)58553Laparoscopy, surgical, with vaginal hysterectomy, foruterus greater than 250 g;58554Laparoscopy, surgical, with vaginal hysterectomy, foruterus greater than 250 g; with removal of tube(s) and/orovary(s)58570Laparoscopy, surgical, with total hysterectomy, for uterus Facility Only: 829250 g or less;58571Laparoscopy, surgical, with total hysterectomy, for uterus Facility Only: 934250 g or less;58572Laparoscopy, surgical, with total hysterectomy, for uterus Facility Only: 1,066greater than 250 g58573Laparoscopy, surgical, with total hysterectomy, for uterus Facility Only: 1,251greater than 250 g; with removal of tube(s) and/orovary(s)Myomectomy58545Laparoscopy, surgical, myomectomy, excision; 1 to 4 2,363 5,168Laparoscopy, surgical, myomectomy, excision; 5 or more Facility Only: 1,146 3,890 9,096Facility Only: 927intramural myomas with total weight of 250 g or lessand/or removal of surface myomas58546intramural myomas and/or intramural myomas with totalweight greater than 250 gOophorectomy58920Wedge resection or bisection of ovary, unilateral orFacility Only: 738NA 6,933Facility Only: 575Inpatient only, not reimbursed for hospitalbilateral58940Oophorectomy, partial or total, unilateral or bilateral;outpatient or ASC58943Oophorectomy, partial or total, unilateral or bilateral; for Facility Only: 1,202 Inpatient only, not reimbursed for hospitalovarian, tubal or primary peritoneal malignancy, withoutpatient or ASCpara-aortic and pelvic lymph node biopsies, peritonealwashings, peritoneal biopsies, diaphragmaticassessments, with or without salpingectomy(s), with orwithout omentectomy58953Bilateral salpingo-oophorectomy with omentectomy,total abdominal hysterectomy and radical dissection forFacility Only: 2,051 Inpatient only, not reimbursed for hospitaloutpatient or ASCdebulking;58954Bilateral salpingo-oophorectomy with omentectomy,total abdominal hysterectomy and radical dissection fordebulking; with pelvic lymphadenectomy and limitedpara-aortic lymphadenectomy3 Facility Only: 2,219 Inpatient only, not reimbursed for hospitaloutpatient or ASC
CPT Code58956Description2Bilateral salpingo-oophorectomy with total3PhysicianAmbulatorySurgical CenterHospital4Outpatient4Facility Only: 1,394 Inpatient only, not reimbursed for hospitalomentectomy, total abdominal hysterectomy foroutpatient or ASCmalignancyTubal Ligation58600Ligation or transection of fallopian tube(s), abdominal or Facility Only: 382 1,331 2,680vaginal approach, unilateral or bilateral58605Ligation or transection of fallopian tube(s), abdominal or Facility Only: 349Inpatient only, not reimbursed for hospitalvaginal approach, postpartum, unilateral or bilateral,outpatient or ASCduring same hospitalization (separate procedure)58611Ligation or transection of fallopian tube(s) when done atFacility Only: 78the time of cesarean delivery or intra-abdominal surgeryInpatient only, not reimbursed for hospitaloutpatient or ASC(not a separate procedure) (List separately in addition tocode for primary procedure)58615Occlusion of fallopian tube(s) by device (e.g., band,Facility Only: 263 1,331 2,680Facility Only: 384 2,363 5,168Facility Only: 383 2,363 5,168clip, Falope ring) vaginal or suprapubic approach58670Laparoscopy, surgical; with fulguration of oviducts (withor without transection)58671Laparoscopy, surgical; with occlusion of oviducts bydevice (e.g., band, clip, or Falope ring)S2900Surgical techniques requiring use of robotic surgicalHCPCS II S-Codes cannot be reported to Medicare. They aresystem (list separately in addition to code for primaryused only by non-Medicare payers, which may cover andprocedure)price them according to their own requirements4
Hospital Inpatient Procedure Coding for OB/GYN SurgeryICD-10-PCS procedure codes5 are used by hospitals to report surgeries and procedures performed in the inpatient setting. All ICD10-PCS codes have seven digits, each digit representing a specific character associated with procedures. Code assignment in ICD-10PCS is a process of “constructing” the code by selecting values from a code table for each of the seven standard characters. Keycharacters are discussed below.CharacterDescriptionThe two main root operations for removal of tissue are B-Excision and T-Resection. By definition, BExcision involves removing a portion of the body part and T-Resection involves removing the entirebody part. For tubal ligation i.e. sterilization, the root operation depends on the technique:3: Root OperationB-Excision is used for removal of a” knuckle” of the fallopian tube5-Destruction is used for fulguration and cauteryL-Occlusion is used for ligation and division as well as for placement of devices such as rings and clipsNote that physicians may use these terms more broadly. It is the coder’s responsibility to determinewhat the physician’s documentation equates to in terms of ICD-10-PCS definitions. The physician isnot expected to document using ICD-10-PCS code descriptions.2Because each body part is identified distinctly, separate codes are assigned for uterus (i.e. corpus),cervix, ovary, and fallopian tube. This means that many common OB/GYN surgeries require two ormore codes.4: Body PartFor example, ICD-10-PCS requires that two codes be assigned for a total hysterectomy: one removingthe uterus and one code for removing the cervix. Similarly, for a total hysterectomy with bilateralsalpingo-oophorectomy, four codes must be assigned: one each for removing the uterus, cervix, theovaries, and the fallopian tubes.Different codes are constructed depending on the approach:0-Open involves an open incision to directly expose the surgical site5: Approach4-Percutaneous Endoscopic is used for procedures performed via laparoscopy7-Via Natural or Artificial Opening, e.g. vaginal hysterectomyF-Via Natural or Artificial Opening with Percutaneous Endoscopic Assistance, e.g., laparoscopicallyassisted vaginal hysterectomy5
ICD-10-PCS Code5Code DescriptionHysterectomyAdditional codes are assigned for removal of ovaries and fallopian tubes.Supracervical or Subtotal Hysterectomy (excision of uterus without cervix)0UT90ZZResection of uterus, open approach0UT94ZZResection of uterus, percutaneous endoscopic approachTotal Abdominal Hysterectomy, Open (TAH)0UT90ZZResection of uterus, open approachplus0UTC0ZZResection of cervix, open approachTotal Hysterectomy, Laparoscopic (LVH)0UT94ZZResection of uterus, percutaneous endoscopic approachPlus0UTC4ZZTotal Vaginal Hysterectomy (TVH)Resection of cervix, percutaneous endoscopic approach0UT97ZZResection of uterus, via natural or artificial openingplus0UTC7ZZResection of cervix, via natural or artificial openingLaparoscopically Assisted Vaginal Hysterectomy (LAVH)0UT9FZZResection of uterus, via natural or artificial opening with percutaneous endoscopic assistancePlus0UTC7ZZRadical HysterectomyResection of cervix, via natural or artificial openingRadical hysterectomy involves removal of the uterus, cervix, ovaries and fallopian tubes as well as removal of uterine supportingstructures (e.g., ligaments), removal of the vagina, and/or extensive pelvic and aortic lymphadenectomy. Hysterectomy is coded asabove. optional codes are then assigned to capture removal of uterine supporting structures and vagina, and lymphadenectomyas performed.Myomectomy0UB90ZZExcision of uterus, open approach0UB94ZZExcision of uterus, percutaneous endoscopic approachOophorectomy and SalpingectomyExcision of Ovarian Lesion, Wedge Resection0UB00ZZExcision of right ovary, open approach0UB04ZZExcision of right ovary, percutaneous endoscopic approach0UB10ZZExcision of left ovary, open approach0UB14ZZExcision of left ovary, percutaneous endoscopic approach0UB20ZZExcision of bilateral ovaries, open approach0UB24ZZComplete OophorectomyExcision of bilateral ovaries, percutaneous endoscopic approach0UT00ZZResection of right ovary, open approach0UT04ZZResection of right ovary, percutaneous endoscopic approach0UT10ZZResection of left ovary, open approach0UT14ZZResection of left ovary, percutaneous endoscopic approach0UT20ZZResection of bilateral ovaries, open approach0UT24ZZResection of bilateral ovaries, percutaneous endoscopic approach6
ICD-10-PCS Code5Code DescriptionComplete Salpingectomy0UT50ZZResection of right fallopian tube, open approach0UT54ZZResection of right fallopian tube, percutaneous endoscopic approach0UT60ZZResection of left fallopian tube, open approach0UT64ZZResection of left fallopian tube, percutaneous endoscopic approach0UT70ZZResection of bilateral fallopian tubes, open approach0UT74ZZResection of bilateral fallopian tubes, percutaneous endoscopic approachTubal Ligation0U570ZZDestruction of bilateral fallopian tubes, open approach0U574ZZDestruction of bilateral fallopian tubes, percutaneous endoscopic approach0UB70ZZExcision of bilateral fallopian tubes, open approach0UB74ZZExcision of bilateral fallopian tubes, percutaneous endoscopic approach0UL70ZZOcclusion of bilateral fallopian tubes, open approach0UL74ZZOcclusion of bilateral fallopian tubes, percutaneous endoscopic approachRobotic AssistanceCodes for robotic assistance are assigned separately in addition to the primary procedure code.7 8E0W0CZRobotic assisted procedure of trunk region, open approach8E0W4CZRobotic assisted procedure of trunk region, percutaneous endoscopic approach
Hospital Inpatient DRG’s for OB/GYN SurgeryDRG Assignment FY2022—effective October 1, 2021Under Medicare’s MS-DRG methodology for hospital inpatient payment, each inpatient stay is assigned to one of about 750 diagnosisrelated groups, based on the ICD-10 codes assigned to the diagnoses and procedures. Only one MS-DRG is assigned for each inpatientstay, regardless of the number of procedures performed. MS- DRGs shown are those typically assigned to the following scenarios whenthe patient is admitted specifically for the procedure.MS-DRG6DescriptionFY 2022 PaymentHYSTERECTOMY DRGs 734, 735 for Radical Hysterectomy require the presence of additional codes for removal of uterinesupporting structures (e.g., ligaments) and/or extensive pelvic and aortic lymphadenectomy.734Pelvic Evisceration, Radical Hysterectomy and Radical Vulvectomy W CC/MCC 14,668735Pelvic Evisceration, Radical Hysterectomy and Radical Vulvectomy W/O CC/MCC 9,322736Uterine and Adnexa Procedures for Ovarian or Adnexal Malignancy W MCC 28,096737Uterine and Adnexa Procedures for Ovarian or Adnexal Malignancy W CC 13,572738Uterine and Adnexa Procedures for Ovarian or Adnexal Malignancy W/O CC/MCC 9,732739Uterine, Adnexa Procedures for Non-Ovarian/Adnexal Malignancy W MCC 25,216740Uterine, Adnexa Procedures for Non-Ovarian/Adnexal Malignancy W CC 11,880741Uterine, Adnexa Procedures for Non-Ovarian/Adnexal Malignancy W/O CC/MCC 8,440742Uterine and Adnexa Procedures for Non-Malignancy W CC/MCC 11,330743Uterine and Adnexa Procedures for Non-Malignancy W/O CC/MCC 7,470MYOMECTOMY - Myomectomy is typically performed for non-malignant lesions, e.g., fibroids.742Uterine and Adnexa Procedures for Non-Malignancy W CC/MCC 11,330743Uterine and Adnexa Procedures for Non-Malignancy W/O CC/MCC 7,470Oophorectomy and Salpingectomy736Uterine and Adnexa Procedures for Ovarian or Adnexal Malignancy W MCC 28,096737Uterine and Adnexa Procedures for Ovarian or Adnexal Malignancy W CC 13,572738Uterine and Adnexa Procedures for Ovarian or Adnexal Malignancy W/O CC/MCC 9,732739Uterine, Adnexa Procedures for Non-Ovarian/Adnexal Malignancy W MCC 25,216740Uterine, Adnexa Procedures for Non-Ovarian/Adnexal Malignancy W CC 11,880741Uterine, Adnexa Procedures for Non-Ovarian/Adnexal Malignancy W/O CC/MCC 8,440742Uterine and Adnexa Procedures for Non-Malignancy W CC/MCC 11,330743Uterine and Adnexa Procedures for Non-Malignancy W/O CC/MCC 7,470Tubal Ligation8 744D&C, Conization, Laparoscopy and Tubal Interruption W CC/MCC 11,839745D&C, Conization, Laparoscopy and Tubal Interruption W/O CC/MCC 7,715
1Centers for Medicare & Medicaid Services. Alpha-numeric easeCodeSets/HCPCS-Quarterly-Update2CPT copyright 2021 American Medical Association. All rights reserved. CPT is a registered trademark of the American MedicalAssociation. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversionfactors 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 datacontained or not contained herein.3Centers for Medicare and Medicaid Services. Medicare Program; CY 2022 Payment Policies Under the Physician Fee Scheduleand Other Changes to Part B Payment Policies; Federal Register (86 Fed. Reg. No. 221 -2021-11-19/pdf/2021-23972.pdf Published November 19, 2021. Physician Fee Schedule– January 2022 Release. 22a4Centers for Medicare and Medicaid Services. Medicare Program: Hospital Outpatient Prospective Payment and AmbulatorySurgical Center Payment Systems; Final Rule, Federal Register (86 Fed. Reg. No.218 R-2021-11-16/pdf/2021-24011.pdf Published November 16, 2021. ASC Payment Rates –Addenda January 2022 ASC Approved HCPCS Code and Payment Rates-Updated January 4, -Service-Payment/ASCPayment/11 Addenda Updates5Department of Health and Human Services, Centers for Medicare & Medicaid Services. International Classification of Diseases,Tenth Revision, Procedure Coding System (ICD-10-PCS). 6Centers for Medicare and Medicaid Services. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute CareHospitals and the LongTerm Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2022 Rates; FinalRule, Federal Register (86 Fed. Reg. No. 154 44774-45615), pdf/202116519.pdf Published August 13, 2021.Medtronic provides this information for your convenience only. It does not constitute legal advice or a recommendation regardingclinical practice. Information provided is gathered from third-party sources and is subject to change without notice due tofrequently changing laws, rules and regulations. The provider has the responsibility to determine medical necessity and to submitappropriate codes and charges for care provided. Medtronic makes no guarantee that the use of this information will preventdifferences of opinion or disputes with Medicare or other payers as to the correct form of billing or the amount that will be paid toproviders of service. Please contact your Medicare contractor, other payers, reimbursement specialists and/or legal counsel forinterpretation of coding, coverage and payment policies. This document provides assistance for FDA approved or clearedindications. Where reimbursement is sought for use of a product that may be inconsistent with, or not expressly specified in, theFDA cleared or approved labeling (e.g., instructions for use, operator’s manual or package insert), consult with your billing advisorsor payers on handling such billing issues. Some payers may have policies that make it inappropriate to submit claims for such itemsor related service. 2022 Medtronic. All rights reserved. Medtronic, Medtronic logo and Engineering the Extradentary are trademarks of Medtronic. *Third party brands are trademarks of their respective owners. All other brands are trademarks of a Medtronic company. 01/2022 USUW-21000099
Expanded Model Emergency Policy; Coding and Payment for Virtual Check -in Services Interim Final Rule Policy; Coding and Payment for Personal Protective Equipment (PPE) Interim Final Rule Policy; Regulatory Revisions in Response to the Public Health Emergency (PHE) for COVID -19; and Finalization of Certain Provisions from the March 3 1st, May .
