Coding Corner: Incorporate These CPT Changes Into Your Outpatient Department

Gear up for a new array of venous access codes

Revamped integumentary, surgical, and radiological codes headline the CPT code changes for 2004 - and a handful of new venous access codes will have you reading the fine print for details on exactly who performed the procedure and how old the patient is.                            

Take a look at top CPT changes:

Read the Fine Print With Integumentary Codes
You'll need to pay special attention to new instructional notes for several of the integumentary procedure codes, particularly those for biopsies and adjacent tissue transfers. For example, you should report codes 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) and +11101 (... each separate/additional lesion) when the only procedure the physician performs is the obtaining of the specimen, says Andrea Clark, RHIA, CCS, CPC-H, with Health Revenue Assurance Associates Inc. in Chapel Hill, N.C. And when the doctor performs an additional procedure - such as excision of lesions - in the same anatomic spot, you shouldn't report the biopsy separately because it is included in those codes. 
 
If she performs the biopsy in a different anatomic site, however, you can report it separately, says Clark, who presented on CPT changes at the Third Annual Coding, Billing, and Compliance Essentials Conference in Orlando, Fla. Revised code 11100 will include a simple closure, so unless special circumstances prompt the physician to perform an intermediate or complex closure, you should not report closure separately.
And for adjacent tissue transfer and rearrangement, CPT offers new instructions on skin grafts and defects: "Defects" now describes both primary and secondary defects, and you need to measure them together to determine the appropriate code. The primary defect is the one resulting from the excision, and the secondary results from flap design, Clark says.
Read the Fine Print for Surgical Services
You'll have new notes and examples to take into account when reporting certain surgical procedures, so make sure you're aware of the accessory information associated with these codes.
For instance, code series 11770-11772 (Excision of pilonidal cyst or sinus) now has a note directing you to report 10080-10081 (Incision and drainage of pilonidal cyst) when the physician performs incision and drainage rather than a formal excision. "10080 will represent most of the services provided," says Mike Granovsky, MD, CPC, FACEP, chief financial officer of Greater Washington Emergency Physicians in Fort Washington, Md.
Pay attention to details when using codes 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar "fascia"] ), 20551 (...; single tendon origin/insertion), 20552 (Injections[s]; single or multiple trigger point[s], one or two muscle[s]), and 20553 (...; single or multiple trigger point[s], three or [...]

- Published on 2004-01-01