General Surgery Coding Alert

Don’t miss new CPT^® 2013 edit pairs that could compromise pay.

You’ve barely gotten used to how the new, revised, and deleted CPT^®2013 codes will impact reporting your general surgeon’s services. Now you need to deal with first quarter changes to Medicare’s Correct Coding Initiative (CCI). Learn how to maneuver new edit pairs -- many of which involve the CPT^® code changes -- to keep your surgeon’s pay on the up-and-up.

CCI 19.0, which took effect on January 1, 2013, adds 37,587 new bundles and deletes 16, 716. Read on to find out which CCI changes you need to know for your general surgery coding.

Count Intraoperative Services as Included

Medicare specifies that when you bill a surgical code, the procedure includes all intraoperative services that are usual and necessary parts of the surgery. That’s why CCI 19.0 contains lots of new edit pairs with the following new CPT^® 2013 codes that you might use in your surgical practice this year:

36221-36228 -- (non-selective or selective)… catheter placement …(for specific arteries)

37197 -- Transcatheter retrieval, percutaneous, of intravascular foreign body …

37211-37214 -- Transcatheter therapy … infusion for thrombolysis …

43206 and 43252 -- (Esophagoscopy or upper gastrointestinal endoscopy)… with optical endomicroscopy.

Know the column 2 codes: With the above new surgical codes in column 1, CCI 19.0 creates edit pairs with the following procedures that Medicare considers "column 2" codes:

Closure (repair) codes 12001-13150

Venipuncture, IV, infusion, transfusion, or arterial puncture services represented by codes such as 36000, 36400-36410, 36430-36440 36600, 37202, 96360, and 96372

Naso- or oro-gastric tube placement (43752)

Bladder catheter placement (51701-51703)

Many nerve block codes in the range 62310-64530

Operating microscope (+69990)

Many electrocardiogram (ECG) and electroencephalography (EEG) codes such as 93000-93010 and 95812-95822

Pulmonary services such as 94002, 94200, and 94680

Moderate sedation codes such as 99148-+99150.

You should study these bundles carefully, because CCI assigns many of the new edit pairs a "0" modifier indicator, meaning that you cannot override the edit pair under any circumstances.

"These edit pairs fit Medicare’s pattern of bundling ancillary services that are typically part of procedures, "Marcella Bucknam, CPC, CPC-I, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, audit manager for CHAN Healthcare in Vancouver, Wash. "Coders should watch closely for those types of changes and bill accordingly."

Note that Blood Vessel Repair Includes Transcatheter Therapy

Surgical package bundles aren’t the only edit pairs that CCI adds for new CPT^® transcatheter therapy codes 37211-37214. You’ll also find the codes bundled in column 2 with the following procedures (paraphrased or shortened code descriptors):

34800-34805 -- Endovascular repair of infrarenal abdominal aortic aneurysm or dissection …

34825 -- Placement of proximal or distal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, or dissection; initial vessel

36595-36596 -- Mechanical removal of … obstructive material … from central venous device …

36831 and 36833 -- open arteriovenous fistula thrombectomy or revision with thrombectomy

36860-36861 -- External cannula declotting (separate procedure) …

36870 -- Thrombectomy, percutaneous, arteriovenous fistula …

37184-37188 -- … percutaneous transluminal thrombectomy ….

In other words, each of the preceding procedures includes transcatheter infusion for thrombolysis, if performed.

CCI 19.0 also creates mutually exclusive edit pairs for 37211-37214 with 37202 (Transcatheter therapy, infusion other than for thrombolysis, any type [e.g., spasmolytic, vasoconstrictive]).

Avoid Pleural Drainage With Thoracic Procedures

CPT^® 2013 provides two new codes for percutaneous pleural drainage (32556-32557, Pleural drainage, percutaneous, with insertion of indwelling catheter…), and CCI 19.0 adds a host of edit pairs restricting how you can use the codes.

Thoracic procedures inclusive: If your surgeon performs a thoracic surgical procedure, don’t separately bill for 32556-32557, according to CCI 19.0. You’ll see new edit pairs for the following procedures:

34051 -- Thrombectomy by thoracic incision

34502 -- Vena cava reconstruction

35021-35022, 35311 -- Aneurysm repair, thoracic incision

35182 and 35189 -- arteriovenous fistula repair, thorax

35211-35216, 35241-35246, 35271-35276 -- Intrathoracic blood vessel repair

35452 -- Open aortic balloon angioplasty

35691 and 35695 -- Artery transposition and/or reimplantation (thoracic)

35905 -- Infected graft excision, thorax

39000-39220 -- Mediastinum procedures (drainage, cyst or tumor resection)

39501-39503, 39540-39545, 39560-39561 -- Diaphragm laceration or hernia repair or resection

43045 and 43112-43124 -- Esophagotomy

43101-43108 and 43112-43124 -- Esophagus, lesion excision or esophagectomy

Other esophageal procedures (43135, 43310-43314, 43320-43351, 43400-43425).

There’s more: CCI 19.0 also bundles 32556-32557, as well as new codes 32554-32555 (Thoracentesis, needle or catheter, aspiration of the pleural space …) with 19260-19272 (Excision of chest wall tumor including ribs …).

Bundle Endoscopy With Optical Microscopy

If your surgeon performs either of the procedures represented by new CPT^® 2013 codes 43206 and 43252, you need to be aware of a host of CCI 19.0 edit pairs.

Choose most complete procedure: The new edit pairs enforce an important concept: Select the most specific code that describes all parts of the procedure your surgeon performs. Don’t report 43206 or 43252 in addition to any other code for esophagoscopy, upper GI endoscopy, or other upper GI procedure as follows:

43200 -- Esophagoscopy …

43235-43259 -- Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate …

43300-43331 -- esophageal repair procedures

43341-43352 -- esophagojejunostomy or esophagostomy

43610-43641 -- stomach excision procedures

Many codes in the range 43800-43855 -- other gastric procedures.

"Many of these edit pairs have a modifier indicator of ‘0,’ so take care not to try to override the bundled codes with modifier 59 (Distinct procedural service)," Bucknam says.