Catch Up on the Latest HCPCS 2017 Updates for Ob-Gyn

Tue, Aug 8, 2017 --

Coding Updates

ob gyn practice

In “Learn the ABCs (and Zs) of IUD Coding” we covered HCPCS codes available for the supply of the IUD. But coding is ever-changing, and there’s a new option as of July 1 for Kyleena®. Check out that new option and other HCPCS changes effective July 1 relevant to ob-gyn.

Tip: Want to see all the changes? Try the CMS HCPCS Quarterly Update page.

Start With Kyleena IUD

As of July 1, you have this new code for the supply of Kyleena IUD:

  • Q9984, Levonorgestrel-releasing intrauterine contraceptive system (Kyleena), 19.5 mg.

Helpful hint: Don’t get too comfortable with this code. You can expect to see a new J code for Kyleena in January.

For Medicare, Move Away from J1725

When the calendar flipped to July, J1725 (Injection, hydroxyprogesterone caproate, 1 mg) stopped being a valid code for Medicare Part B claims.

But there are two new codes, including one specific to Makena®, used to lower the risk of having a preterm baby:

  • Q9985, Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg
  • Q9986, Makena Injection, hydroxyprogesterone caproate (Makena), 10 mg.

Note: Code J1725 did not get deleted. Check with non-Medicare payers to determine whether they’ve updated to the new Q code.

Make Room for Modifier Modifications

You may recognize these modifiers for reciprocal billing arrangements and locum tenens. They apply across specialties, which means your ob-gyn practice should know them, too.

Before July 1: Here are the old descriptors:

  • Q5, Service furnished by a substitute physician under a reciprocal billing arrangement
  • Q6, Service furnished by a locum tenens physician.

Effective July 1: Take some time to read through the new descriptors, noting the addition of physical therapists:

  • Q5, Service furnished under a reciprocal billing arrangement by a substitute physician; or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
  • Q6, Service furnished under a fee-for-time compensation arrangement by a substitute physician; or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area.

How About You?

Do you like when HCPCS codes include specific brand names? In your experience, do private payers update their systems to accept new Q codes during the year?

 

About 

Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she’s also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more.

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2 Comments For This Post

  1. Lana Owen, CPC Says:

    When would an OB/GYN use Q9985?

  2. Deborah Marsh Says:

    Hi, Lana – Based on HCPCS meeting minutes, it looks like this code developed out of a request by ANI for a code to identify their drug used “to treat advanced adenocarcinoma of the uterine corpus; manage amenorrhea and abnormal uterine bleeding due to hormonal imbalance in the absence of organic pathology; to test for endogenous estrogen production; and to produce secretory endometrium and desquamation.” The meeting minutes are here: http://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/Downloads/2017-05-16-HCPCS-Public-Meeting-Agenda.pdf. As an NOS code, it technically has wider applicability. Melanie Witt has a post on TCI forum, too: http://forum.codinginstitute.com/t/ob-gyn/q9985-q9986-july-2017-936251 – Hope that helps!

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