2014 OB/GYN Surgery Medicare Reimbursement Coding Guide

2014 OB/GYN Surgery Medicare Reimbursement Coding Guide Effective January 1, 2014 Medicare National Average Rates and Allowables (Not Adjusted For Geography) CPT * HCPCS Code 58150 58152 58180 58200 58210 58240 58541 58542 58543 Procedure ABDOMINAL HYSTERECTOMY Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (eg, Marshall- Marchetti-Krantz, Burch) Supracervical abdominal hysterectomy (subtotal hysterectomy), with or without removal of tube(s), with or without removal of ovary(s) Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube(s), with or without removal of ovary(s) Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tube(s), with or without removal of ovary(s) Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof LAPAROSCOPIC HYSTERECTOMY, surgical, supracervical hysterectomy, for uterus 250 g or less;, surgical, supracervical hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s), surgical, supracervical hysterectomy, for uterus greater than 250 g; PHYSICIAN * MPFS (CF=$35.8228) Facility Classification HOSPITAL OUPATIENT Descriptor ** Rate AMBULATORY SURGICAL CENTER *** ASC $1,041.37 Inpatient, not reimbursed in outpatient or $1,296.07 Inpatient, not reimbursed in outpatient or $997.31 Inpatient, not reimbursed in outpatient or $1,381.33 Inpatient, not reimbursed in outpatient or $1,853.83 Inpatient, not reimbursed in outpatient or $2,944.99 Inpatient, not reimbursed in outpatient or $897.36 0132 $1,003.40 0132 $1,018.80 0132 I I I $5,365.42 $2,963.97 $5,365.42 $2,963.97 $5,365.42

CPT * HCPCS Code 58544 58548 58550 58552 58553 58554 58570 58571 58572 58573 58920 Procedure, surgical, supracervical hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/ or ovary(s), surgical, with radical hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with removal of tube(s) and ovary(s), if performed, surgical, with vaginal hysterectomy, for uterus 250 g or less;, surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s), surgical, with vaginal hysterectomy, for uterus greater than 250 g;, surgical, with vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/ or ovary(s), surgical, with total hysterectomy, for uterus 250 g or less;, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s), surgical, with total hysterectomy, for uterus greater than 250 g;, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) Wedge resection or bisection of ovary, unilateral or bilateral PHYSICIAN * MPFS (CF=$35.8228) Facility Classification $1,106.92 0132 HOSPITAL OUPATIENT Descriptor I ** Rate $5,365.42 AMBULATORY SURGICAL CENTER *** ASC $1,906.85 Inpatient, not reimbursed in outpatient or $918.14 0132 $1,020.59 0131 $1,181.79 0131 $1,372.01 0131 $966.14 0131 $1,081.85 0131 $1,204.36 0131 $1,387.42 0131 $742.96 0195 I $5,365.42 $2,963.97 $2,015.50 $2,015.50 $2,015.50 58940 Oophorectomy, partial or total, unilateral or bilateral; $538.42 Inpatient, not reimbursed in outpatient or 58943 58953 58954 58956 Oophorectomy, partial or total, unilateral or bilateral; for ovarian, tubal or primary peritoneal malignancy, with para-aortic and pelvic lymph node biopsies, peritoneal washings, peritoneal biopsies, diaphragmatic assessments, with or without salpingectomy(s), with or without omentectomy Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking; Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking; with pelvic lymphadenectomy and limited paraaortic lymphadenectomy Bilateral salpingo-oophorectomy with total omentectomy, total abdominal hysterectomy for malignancy VAGINAL HYSTERECTOMY 58260 Vaginal hysterectomy, for uterus 250 g or less; $859.75 0195 58262 58263 58267 Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s) Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele Vaginal hysterectomy, for uterus 250 g or less; with colpourethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control $1,190.39 Inpatient, not reimbursed in outpatient or $2,042.62 Inpatient, not reimbursed in outpatient or $2,215.28 Inpatient, not reimbursed in outpatient or $1,394.94 Inpatient, not reimbursed in outpatient or $959.33 0195 $1,030.26 0195 $1,097.61 Inpatient, not reimbursed in outpatient or

PHYSICIAN HOSPITAL OUPATIENT AMBULATORY SURGICAL CENTER CPT * HCPCS Code 58270 Procedure Vaginal hysterectomy, for uterus 250 g or less; with repair of enterocele * MPFS (CF=$35.8228) Facility Classification $917.06 0195 Descriptor ** Rate *** ASC 58275 Vaginal hysterectomy, with total or partial vaginectomy; $1,023.46 Inpatient, not reimbursed in outpatient or 58280 Vaginal hysterectomy, with total or partial vaginectomy; with repair of enterocele $1,094.03 Inpatient, not reimbursed in outpatient or 58285 Vaginal hysterectomy, radical (Schauta type operation) $1,364.85 Inpatient, not reimbursed in outpatient or 58290 Vaginal hysterectomy, for uterus greater than 250 g; $1,197.91 0202 58291 58292 58293 58294 Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s), with repair of enterocele Vaginal hysterectomy, for uterus greater than 250 g; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele $1,297.14 0202 $1,368.43 0202 $1,423.60 Inpatient, not reimbursed in outpatient or $1,268.84 0202 NOTES: Multiple Procedure Discounting Multiple surgical procedures furnished during the same operative session are discounted. 50% is paid for any other surgical procedure(s) performed at the same time. The above National Average and ASC (Freestanding) Rates represent the reimbursement amounts paid directly to the facility for the technical portion of the procedure. The Physician (surgeon) would separately receive the professional fee (MPFS Allowable) for the procedure performed. TABLE REFERENCES: * PFS Relative Value File, RVU14A (12-19-13), effective January 1, 2014 ** January 2014 HOPPS Addenda A and B (12-19-13), effective January 1, 2014 *** January 2014 ASC Addendum AA, BB, DD1, DD2, and EE (1-2-14), effective January 1, 2014 ICD-9-CM Volume 3 Hospital Procedure Codes Procedure Code* HYSTERECTOMY 68.31 Laparoscopic supracervical hysterectomy [LSH] 68.39 Other and unspecified subtotal abdominal hysterectomy 68.41 Laparoscopic total abdominal hysterectomy 68.49 Other and unspecified total abdominal hysterectomy 68.51 Laparoscopically assisted vaginal hysterectomy (LAVH) 68.59 Other and unspecified vaginal hysterectomy 68.61 Laparoscopic radical abdominal hysterectomy 68.69 Other and unspecified radical abdominal hysterectomy 68.71 Laparoscopic radical vaginal hysterectomy [LRVH] 68.79 Other and unspecified radical vaginal hysterectomy 68.9 Other and unspecified hysterectomy 65.31 Laparoscopic unilateral oophorectomy 65.39 Other unilateral oophorectomy 65.41 Laparoscopic unilateral salpingo-oophorectomy 65.49 Other unilateral salpingo-oophorectomy 65.51 Other removal of both ovaries at same operative episode 65.52 Other removal of remaining ovary

Procedure Code* 65.53 Laparoscopic removal of both ovaries at same operative episode 65.61 Other removal of both ovaries and tubes at same operative episode 65.62 Other removal of remaining ovary and tube 65.63 Laparoscopic removal of both ovaries and tubes at same operative episode 65.64 Laparoscopic removal of remaining ovary and tube NOTES: The ICD-9-CM Hospital Procedure Codes listed above may be used in the MS-DRG Classifications (See Inpatient DRG Payment Rates Table) The appropriate MS-DRG classification is also dependent on the diagnosis code, demographics, sex and possible co-conditions. TABLE REFERENCES: *2014 Hospital ICD-9-CM Volume 3, 9th Revision, Clinical Modification, Sixth Edition Inpatient DRG Payment Rates MS-DRG* MS-DRG Title Arithmetic Mean Length of Stay (Days) National Average Payment** HYSTERECTOMY 734 Pelvic Evisceration, Rad Hysterectomy and Rad Vulvectomy w CC/MCC 6.7 $14,816.21 735 Pelvic Evisceration, Rad Hysterectomy and Rad Vulvectomy w/o CC/MCC 2.3 $6,907.31 736 Uterine and Adnexa Proc for Ovarian or Adnexal Malignancy w MCC 12.4 $24,480.65 737 Uterine and Adnexa Proc for Ovarian or Adnexal Malignancy w CC 6.2 $11,778.97 738 Uterine and Adnexa Proc for Ovarian or Adnexal Malignancy w/o CC/MCC 3.3 $7,308.64 739 Uterine, Adnexa Proc for Non-Ovarian/Adnexal Malig w MCC 8.7 $18,353.96 740 Uterine, Adnexa Proc for Non-Ovarian/Adnexal Malig w CC 4.1 $9,174.37 741 Uterine, Adnexa Proc for Non-Ovarian/Adnexal Malig w/o CC/MCC 2.1 $6,652.13 742 Uterine and Adnexa Proc for Non-Malignancy w CC/MCC 4.0 $8,683.15 743 Uterine and Adnexa Proc for Non-Malignancy w/o CC/MCC 1.9 $5,743.33 736 Uterine and Adnexa Proc for Ovarian or Adnexal Malignancy w MCC 12.4 $24,480.65 737 Uterine and Adnexa Proc for Ovarian or Adnexal Malignancy w CC 6.2 $11,778.97 738 Uterine and Adnexa Proc for Ovarian or Adnexal Malignancy w/o CC/MCC 3.3 $7,308.64 739 Uterine, Adnexa Proc for Non-Ovarian/Adnexal Malig w MCC 8.7 $18,353.96 740 Uterine, Adnexa Proc for Non-Ovarian/Adnexal Malig w CC 4.1 $9,174.37 741 Uterine, Adnexa Proc for Non-Ovarian/Adnexal Malig w/o CC/MCC 2.1 $6,652.13 742 Uterine and Adnexa Proc for Non-Malignancy w CC/MCC 4.0 $8,683.15 743 Uterine and Adnexa Proc for Non-Malignancy w/o CC/MCC 1.9 $5,743.33 NOTE: *One DRG per patient is assigned to each inpatient stay. TABLE REFERENCES: ** FY 2014 Final Rule, Federal Register, Vol. 78, No. 160, Monday, August 19, 2013, Table 1A-1E. National Average Payment Rate is based upon the National Average Operating Standardized Amount ($5,370.28) plus the Capital Standard Federal Payment Rate ($429.31). ICD-9-CM Diagnosis Codes Dx Code** HYSTERECTOMY 182.0 Malignant neoplasm of corpus uteri, except isthmus 182.1 Malignant neoplasm of isthmus 182.8 Malignant neoplasm of other specified sites of body of uterus 218.x* Uterine leiomyoma 618.1 Uterine prolapse without mention of vaginal wall prolapse 618.2 Uterovaginal prolapse, incomplete 618.3 Uterovaginal prolapse, complete 618.4 Uterovaginal prolapse, unspecified 618.9 Unspecified genital prolapse 621.0 Polyp of corpus uteri

Dx Code** 621.35 Endometrial intraepithelial neoplasia [EIN] 621.4 Hematometra 621.5 Intrauterine synechiae 621.8 Other specified disorders of uterus, not elsewhere classified 621.9 Unspecified disorder of uterus 625.9 Unspecified symptom associated with female genital organs 626.2 Excessive or frequent menstruation 626.6 Metrorrhagia 626.8 Other disorders of menstruation and other abnormal bleeding from female genital tract 626.9 Unspecified disorders of menstruation and other abnormal bleeding from female genital tract 627.0 Premenopausal menorrhagia 627.1 Postmenopausal bleeding 182.0 Malignant neoplasm of corpus uteri, except isthmus 182.1 Malignant neoplasm of isthmus 182.8 Malignant neoplasm of other specified sites of body of uterus 183.0 Malignant neoplasm of ovary 183.2 Malignant neoplasm of fallopian tube 183.3 Malignant neoplasm of broad ligament of uterus 183.4 Malignant neoplasm of parametrium 183.5 Malignant neoplasm of round ligament of uterus 183.8 Malignant neoplasm of other specified sites of uterine adnexa 183.9 Malignant neoplasm of uterine adnexa, unspecified site 220 Benign neoplasm of ovary 620.0 Follicular cyst of ovary 620.1 Corpus luteum cyst or hematoma 620.2 Other and unspecified ovarian cyst 620.4 Prolapse or hernia of ovary and fallopian tube NOTES: *Check 4th or 5th digit. REFERENCE: **2014 Hospital ICD-9-CM Volume 1 and 2, 9th Revision, Clinical Modification, Sixth Edition

Disclaimer: The information contained in this guide is provided to help you understand the reimbursement process. It is not intended to increase or maximize reimbursement by any payer. We strongly recommend that providers consult their payer organization with regard to local reimbursement policies. The information contained in this guide is provided for information purposes only and represents no statement, promise or guarantee by Covidien concerning levels of reimbursement, payment or charge. Similarly, all CPT HCPCS and ICD-9-CM codes are supplied for information purposes only and represent no statement, promise or guarantee by Covidien that these codes will be appropriate or that reimbursement will be made. ICD-9-CM is based on the official version of the World Health Organization s Ninth Revision, International Classification of Diseases. CPT codes and descriptions only are copyright 2013 American Medical Association. All rights reserved. CPT does not include fee schedules, relative values or related listings. The source for this information is the Centers for Medicare and Medicaid Services (CMS). Reimbursement rates reflected in this guide are Medicare National Average rates as published by CMS at the time of printing, and do not reflect provider payment adjustment factors such geographic adjustment, participation as a Disproportionate Share or Teaching Hospital, participation in the CMS Shared Service (ACO) program, or Value Base Purchasing adjustments. The content provided by CMS is updated frequently. It is the responsibility of the health services provider to confirm the appropriate coding required by their local Medicare Administrative Contractors (MACs), carriers, fiscal intermediaries and commercial payers. All Current Procedural Terminology (CPT) five-digit numeric codes, descriptions, numeric modifiers, instructions, guidelines and other material are copyright 2013 American Medical Association. All rights reserved. Code associations and values have been reviewed and validated by NMD Healthcare, Inc. COVIDIEN, COVIDIEN with logo, Covidien logo and positive results for life are U.S. and internationally registered trademarks of Covidien AG. * Trademark of its respective owner. 2014 Covidien. 3.14 US140141 5920 Longbow Drive Boulder, CO 80301 303-530-2300 [t] 800-255-8522 [us] www.covidien.com/reimbursement