General Surgery Coding Alert

Reworked esophagoscopy codes take a hit, too.

New CPT® codes might make life easier for your general surgery practice each January, but you can always count on new Correct Coding Initiative (CCI) edits to follow and complicate things.

This year is no different. “As is customary for the first update of a given year, there are a lot of new edit pairs: 61,120 to be exact,” says Frank Cohen, MPA, MBB, principal and senior analyst for The Frank Cohen Group in Clearwater, Fla. “Factor in the number of terminations (13,107) and we see a net gain this coming quarter of 48,013 new edit pairs.”

Read on, because you can’t afford to miss over 7500 new CCI bundles that could impact your general surgery coding and billing.

Bundle New Drainage Codes

Expect plenty of CCI restrictions with the following new CPT® 2014 codes:

• 10030 — Image-guided fluid collection drainage by catheter (e.g., abscess, hematoma, seroma, lymphocele, cyst), soft tissue (e.g., extremity, abdominal wall, neck), percutaneous
  
• 49405 — Image-guided fluid collection drainage by catheter (e.g., abscess, hematoma, seroma, lymphocele, cyst); visceral (e.g., kidney, liver, spleen, lung/mediastinum), percutaneous
  
• 49406 — … peritoneal or retroperitoneal, percutaneous
  
• 49407 — … peritoneal or retroperitoneal, transvaginal or transrectal.
  

You read about these four codes in “10030 Leads Fluid-Collection Updates” (General Surgery Coding Alert Vol. 16 No. 2), and they account for nearly 1000 new CCI edit pairs you need to know. Many of the bundles are in the following code ranges:

• Integumentary surgical repair (closure) procedure codes 12001-13153
• Thoracoscopy codes in the range 32601-32609
• Venous procedure codes 36000-36410 and 36420-36440
• Arterial procedure codes 36600 and 36640
• Transcatheter infusion code 37202
• Naso- or oro-gastric tube placement code 43752
• Bladder catheter codes 51701-51703
• Spinal therapeutic injection codes 62310-62319
• Nerve block injection codes 64400-64530
• Microsurgical technique code 69990
• Image guided needle placement codes in the range 75989 to 77021
• Cardiography codes 93000-93010, 93040-93042, and 93318
• Pulmonary diagnostic test codes 94200, 94250, 94680-94690, and 94770
• Infusion codes 96360-96365, 96372, and 96374-96376
• Moderate sedation codes 99143-99150
• More than 50 evaluation and management (E/M) codes in the 99211-99449 range.

Need to know: Many of these edit pairs have a modifier indicator of “0,” not “1,” such as 10030 bundled with moderate sedation codes 99143- 99150 in column 2.

The “0” indicator means that you cannot unbundle the two codes under any circumstances, says Chandra L. Hines, practice supervisor of Wake Specialty Physicians in Raleigh, NC. An indicator of “1,” however, means that you may use a modifier to override the edit if the clinical circumstances warrant separate payment, she adds.

Beware Consultative Services and TCM Restrictions

Thousands of additional edits apply to time your surgeon spends on the telephone or internet with assessments and consultations that you can report with new CPT® 2014 codes 99446-99449 (Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional …).

With these edits, CCI essentially specifies that the consults are inherent to many surgical services you might report, such as 44120 (Enterectomy, resection of small intestine; single resection and anastomosis).

Bottom line: Don’t automatically include one of the TCM or phone/internet consultation codes to a claim just because your surgeon provided the service and has supporting documentation. Chances are, CCI considers the service part of the wider-scope procedure your physician performed.

Watch For Esophagoscopy Edits

CCI 20.0 bundles many of the new rigid endoscopy codes (43191-43196, Esophagoscopy, rigid …) and flexible esophagoscopy codes (43197-43198, Esophagoscopy, flexible, transnasal…) with revised and new codes 43260-43278 (Endoscopic retrograde cholangiopancreatography [ERCP];…) and 44360-44379 (Small intestinal endoscopy, enteroscopy beyond second portion of duodenum…).

You’ll also find that CCI 20.0 bundles most of the new esophagoscopy and ERCP codes with intubation procedures, such as the following:

• 43752 — Naso- or oro-gastric tube placement, requiring physician’s skill and fluoroscopic guidance (includes fluoroscopy, image documentation and report)
• 43753 — Gastric intubation and aspiration(s) therapeutic, necessitating physician’s skill (e.g., for gastrointestinal hemorrhage), including lavage if performed
• 43754 — Gastric intubation and aspiration, diagnostic; single specimen (e.g., acid analysis)
• 43756 — Duodenal intubation and aspiration, diagnostic, includes image guidance; single specimen (e.g., bile study for crystals or afferent loop culture).

Remember: CCI already bundles these intubation procedures with existing endoscopy codes, so you should be familiar with this restriction.