General Surgery Coding Alert

Look for 0228T, 0230T bundles, too.

Make sure you keep your general surgery practice in compliance by implementing Correct Coding Initiative (CCI) fourth quarter changes, which went into effect Oct. 1. CCI version 16.3 introduces 19,667 new edit pairs, as well as changes to the modifier indicator for 83 edit pairs, according to Frank D. Cohen, MPA, MBB, senior analyst with MIT Solutions, Inc. But don't worry; you won't have to sort through all those changes.

We've done it for you. To keep your general surgery practice on the up and up this quarter, here's what you need to know.

Include Intestinal Sutures, Diagnostic Lap in Abdominal Procedures

CCI 16.3 includes many additions that will impact your surgery practice by creating over 500 edit pairs involving the following codes:

• 44602 -- Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture; single perforation
• 44603 -- ... multiple perforations
• 44604 -- Suture of large intestine (colorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture (single or multiple perforations); without colostomy
• 44605 -- ... with colostomy

CCI bundles these codes with most open and laparoscopic abdominal or thoracic procedures involving the digestive system under its "standards of medical/surgical practice" policy. "In other words, CCI 16.3 indicates that you should not separately bill for enterorrhaphy as part of a more comprehensive procedure, because the sutures are a normal component of many abdominal surgeries," explains Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program.

Tip: Because these edits are so widespread, "Be careful not to rely on your memory of what is bundled, but check the edits each time you're billing for one of the intestinal suture procedures," Bucknam says.

Learn new diagnostic laparoscopy limits: Edit pairs that restrict diagnostic laparoscopy with laparoscopic surgeries have been around for years. But CCI 16.3 adds over 300 new edit pairs for 49320 " Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) with many open abdominal surgeries, such as 44120 (Enterectomy, resection of small intestine; single resection and anastomosis).

Modifier indicator "1": CCI lists these new intestinal suture and diagnostic abdominal laparoscopic edit pairs with a modifier indicator of 1, meaning that you can unbundle the edit pairs, when appropriate.

Bottom line: You'll need to be familiar with new edit pairs involving hundreds of 40000 level codes bundled with intestinal suture codes 44602-44605, as well as diagnostic laparoscopy code 49320. Look to "Associated Modifiers" at the end of this article to see the conditions that warrant unbundling.

"If you're billing for two distinct surgical procedures subject to a CCI edit, you'll  have to use 59 (Distinct procedural service) to override the edit pair," Bucknam says.

Beware New Category III Edit Pairs

Most of the new CCI 16.3 additions revolve around the newly-introduced Category III CPT codes that went into effect on July 1, as follows:

• 0228T -- Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; single level
• 0230T -- Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; single level

Codes 0228T and 0230T apply when the physician uses ultrasound guidance while administering transforaminal epidural injections.

CCI 16.3 bundles these codes into thousands of other codes spanning throughout every section of CPT. The edit pairs apply to nearly every procedure your general surgeon might perform, from the integumentary system (10000s) through the digestive system (40000s) and beyond.

Modifier indicator "0": In most of the new edit pairs involving these category III codes, CCI has a modifier indicator of 0 -- meaning that no modifier can separate the edits bundling 0228T and 0230T into other codes under any circumstance.

Reap Benefit of Modifier Indicator Change

CCI 16.3 revised the modifier indicator for over 80 edit pairs.

Among the changes from modifier indicator 0 to 1, CCI now allows you to now use a modifier to separate the edits bundling 64530 (Injection, anesthetic agent; celiac plexus, with or without radiologic monitoring) into endoscopy codes 43232, 43238, and 43242. In the past, you could not use any modifiers to separate these services if you performed them during the same session, but effective Oct. 1, you'll be able to use a modifier (such as 59) to separate these edits when your surgeon performs separately identifiable services during the same session.