Coding & Reimbursement Resources

    The AUGS Coding and Reimbursement Committee assists members with the application of governmental regulations and guidelines regarding terminology and CPT/ICD coding in urogynecologic practice. Such information is intended to assist with the coding process as required by governmental regulation and should not be construed as policy sanctioned by AUGS. The following resources are available:

    Coding Updates & Changes

    Establishing Reimbursement Amounts for Procedures, It’s in Your Hands!

    United Healthcare policies regarding hysterectomy may impact preauthorization and reimbursement

    Use of Modifiers with NCCI Edits when Clinical Circumstances are Appropriate

    Vaginal Hysterectomy Coding Update: Claims Eligible for Resubmission on April 1, 2015

    View AUGS' letter to NCCI on Opposition to edits for vaginal hysterectomy procedure and colporrhaphy, colpopexy, and vaginal repair procedures October 23, 2014. View NCCI's response in regards to this letter on November 6, 2014.

    View NCCI letter in response to Enterolysis and lysis of adhesion PTP edits

    AUGS letter in opposition to edits regarding Laparascopic, surgical, with vaginal hysterectomy procedure codes submitted 11/2015

    NCCI Response to Laparascopic hysterectomy procedure code edits


    Submit a Coding Question

    Coding Q&A for AUGS Members (log in to AUGS website required to access feature)

    AUGS Coding Today  (e-mail Mitra Aminrazavi at info@augs.org for a 30-day free trial).

     

    Physican Reimbursement Resources

    Understanding the RUC Survey Instrument
    A resource developed by the American Medical Association.

    New United HealthCare policies require additional preauthorization for certain procedures based on site of service
    AUGS is notifying its Members of increased payer requirements from United Healthcare regarding the location of service for certain surgical procedures, in part due to variability in reimbursement based on the site of service.  Many hospital systems provide a variety of surgical locations and facility charges can vary depending on venue in a hospital or an ambulatory surgical center setting. Click here for an educational fact sheet regarding these changes and what you can do to help.

    Interstim implantation
    It has been brought to the attention of the AUGS coding committee that claims for Interstim implantation (64590) may be denied for Novitas beneficiaries.  Novitas is the Medicare contractor which spans Pennsylvania, New Jersey, Maryland, Delaware, Washington D.C, Colorado, Oklahoma, New Mexico, Texas, Arkansas, Louisiana, Mississippi, Indian Health Service, and Veterans Affairs.

    This is reportedly the result of a claims processing system error which  has resulted in a CPT –ICD9 mismatch.  This appears to be affecting claims from May 2015 to the present.  Claims for the sacral lead placement are not currently affected.

    Novitas is aware of the system error.  Physicians are advised to contact Novitas Customer Care to report the denial and ask that the claim be escalated.

    CMS Conversion Factor
    Change Request (CR) 9104 informs MACs about the release of pyament files based upon the CY 2015 Medicare Physician Fee Schedule (MPFS) Final Rule.  To be sure that you and your billing staff are of these changes, please click here for the New CMS Conversion Factor
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    Fact Sheets

    Pessary Coding

    Coding for Surgical Procedures Involving the Use of Mesh

    Sling Revision and Urethrolysis 

    E&M Form (Sample): Initial Exam


    Links of Interest

    CMS Medicare Physician Fee Schedule for CY 2016

    CMS website for CPT coding and bundling

    CMS resource for Physician Supervision of Diagnostic Tests

    CMS website for Meaningful Use

    Disclaimer:
    The Coding and Reimbursement Committee of the American Urogynecologic Society (AUGS) assists members with the application of governmental regulations and guidelines regarding terminology and CPT/ICD coding in urogynecologic practice. Such information is intended to assist with the coding process as required by governmental regulation and should not be construed as policy sanctioned by AUGS. AUGS disclaims liability for actions or consequences related to any of the information provided.  AUGS does not endorse the diagnostic protocol or treatment plan designed by the provider.


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