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:
New 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
View AUGS' letter sent to NCCI on October 23, 2014.
View NCCI's response letter on November 6, 2014.
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 firstname.lastname@example.org for a 30-day free trial).
Physican Reimbursement Resources
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.
New CMS Conversion Factor
Coding for Surgical Procedures Involving the Use of Mesh
Sling Revision and Urethrolysis
E&M Form (Sample): Initial Exam
Links of Interest
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.