General Surgery Coding Alert

Modifier indicator ‘0’ leaves few options.

Don’t get too excited about the many surgical procedure edit pairs deleted in Correct Coding Initiative (CCI) version 19.3, effective Oct. 1.

Although the latest version “contains some real surprises,” as Frank Cohen, MPA, MBB, principal and senior analyst for The Frank Cohen Group in Clearwater, Fla says — many of them won’t make you happy.

For instance: Of the nearly 30 deleted edit pairs of digestive system (CPT^® 40000 level) codes, almost all make an appearance as new CCI 19.3 edit pairs under a different guise. And the change will be worse for you — with many code pairs changing to modifier indicator “0,” meaning no override allowed.

Take Care With Esophageal Procedure Edits

CCI 19.3 limits how you can report many esophageal procedures in the range 43107-43124. That includes total or near total esophagectomy (43107-43113) and partial esophagectomy (43166-43123).

You’ll find each of the codes in the range 43107-43124 bundled with many of the other codes in the range, as well as with 38746 (Thoracic lymphadenectomy by thoracotomy, mediastinal and regional lymphadenectomy [List separately in addition to code for primary procedure]).

Of the 34 new bundles relating to these codes, seven edit pairs are among those deleted in this update. The difference is that the new edit pairs switch which is the column 1 and column 2 code, and change the modifier indicator from “1” to “0.” “That means you can’t override the new edit pairs even if clinical circumstances and documentation indicate that your surgeon performed two distinct procedures,” explains Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPC-I, CCC, COBGC, internal audit manager at CHAN Healthcare in Vancouver, Wash.

Beware Enterectomy/Colectomy Bundles

You need to pay attention to the latest CCI update if you bill for enterectomy procedures in the range 44120-44133. CCI bundles many of these codes with each other, and with +44203 (Laparoscopy, surgical; each additional small intestine resection and anastomosis [List separately in addition to code for primary procedure]).

“The 44120-44133 codes are for open procedures, so you should reserve +44203 to report laparoscopic small intestine resections in addition to the primary lap procedure, 44202 (Laparoscopy, surgical; enterectomy, resection of small intestine, single resection and anastomosis), Bucknam says.

Colectomy too: You’ll also find many new edit pairs for colectomy procedures 44140-44160. CCI 19.3 also bundles lap enterectomy and colectomy codes 44202-44212 with each other.

As with the esophageal codes, many of the new edit pairs are really deleted edit pairs under a new guise. Eighteen of the 64 new enterectomy/colectomy bundles pair the same two codes that are part of CCI 19.3 code deletions. Again, the new edit pairs swap column 1 column 2 positions and change the modifier indicator to “0,” in many cases. 

Don’t Miss Appendix Additions

Don’t report various appendectomy codes together because they’re mutually exclusive. That’s the word from CCI 19.3, which bundles codes in the range 44950-44970.

“These new edit pairs shouldn’t represent a problem, because your surgeon will remove an appendix by one method or another (such as open or laparoscopic), not both,” Bucknam says.

You should select the single code that most closely describes the clinical circumstances of your surgeon’s work.