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:
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
- Access an excel grid of all the edit pairs with their CPT descriptors
- 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
- Effective 1/1/15 NCCI no longer allows cystoscopy to be billed separately from gynecologic surgical procedures, such as hysterectomy or colpopexy when done for the purpose of checking the integrity of the bladder and ureteral patency
- Approval for use of modifier with CPT code 57267
Coding for Robotic Surgery
Coding for Urodynamic Procedures
Posterior Tibial Nerve Stimulation (PTNS) Therapy
Coding for Laparoscopic Sacral Colpopexy
Coding for Surgical Procedures Involving the Use of Mesh- *Coming Soon*
Submit a Coding Question
Coding Q&A for AUGS Members (log in to AUGS website required to access feature)
AUGSCodingToday (e-mail Mitra Aminrazavi at firstname.lastname@example.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 our attention 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
Links of Interest
- CMS Medicare Physician Fee Schedule for CY 2017
- CMS website for CPT coding and bundling
- CMS resource for Physician Supervision of Diagnostic Tests
- CMS website for Meaningful Use
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.