General Surgery Coding Alert

Watch modifier indicator for override options.

When certain procedures are a standard part of more comprehensive services that your general surgeon performs, you can be certain Medicare’s Correct Coding Initiative (CCI) will establish edit pairs that you need to know. Such is the case with CCI 19.1, effective April 1, 2013.

Although the latest Correct Coding Initiative (CCI) update is “probably the smallest impact I have seen since the beginning of the program,” according Frank D. Cohen, MPA, MBB,senior analyst with The Frank Cohen Group, LLC, that doesn’t mean your general surgery practice will get off easy. “Of the new edit pairs, around 80 percent are surgical codes for both column 1 and column 2,” Cohen says.

Read on to see what you need to know to comply with the latest CCI update.

Include Vessel Exploration/Lysis With Other Procedures

CCI 19.1 bundles the following vessel exploration codes in column 2 with a host of other surgical procedures:

·         35701 — Exploration (not followed by surgical repair), with or without lysis of artery; carotid artery

·         35721 — … femoral artery

·         35741 — … popliteal artery

·         35761 — … other vessels

For instance: Arterial transposition codes involving the carotid artery (35691, 35694, 35695, Transposition and/or reimplantation…) are column 1 codes with 35701 in CCI 19.1.

“The general principle is that vessel exploration/lysis is included in the code for more comprehensive vessel procedures,” explains Marcella Bucknam, CPC, CPC-I, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC,audit manager for CHAN Healthcare in Vancouver, Wash.

Nix Separate Code for Abdominal Paracentesis/Lavage

CCI 19.1 also bundles the following abdominal paracentesis/lavage codes with a host of abdominal procedure codes:

·         49082 — Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance

·         49083 — … with imaging guidance

·         49084 — … Peritoneal lavage, including imaging guidance, when performed

Example: Code 38570 (Laparoscopy, surgical; with retroperitoneal lymph node sampling [biopsy], single or multiple) is a column 1 code for 49082-49084 in CCI 19.1.

“These edit pairs follow a similar logic to the vessel bundles — in this case, the more comprehensive abdominal procedure includes common abdominal surgery practices such as drainage and lavage,” Bucknam says.

Avoid Category III code restriction: Notice that you also shouldn’t bill 49082-49084 in addition to 0312T-0314T (Vagus nerve blocking therapy [morbid obesity]), if your surgeon performs those procedures.

Watch Fundoplasty Bundles

According to a host of new CCI 19.1 edit pairs, you should not separately report fundoplasty procedures represented by the following codes with bariatric surgery and some other pelvic procedures:

·         43280 — Laparoscopy, surgical, esophagogastric fundoplasty (e.g., Nissen, Toupet procedures)

·         43327 — Esophagogastric fundoplasty partial or complete; laparotomy

·         43328 — … thoracotomy

Shun this: Don’t report the preceding fundoplasty codes with gastric restrictive procedures 43842-43847(Gastric restrictive procedure …) or 43770-43775 (Laparoscopy, surgical, gastric restrictive procedure …), according to CCI 19.1.

In fact, these CCI edits show a modifier indicator of “0,” meaning that you cannot override the edit pairs under any circumstances.