General Surgery Coding Alert

Expect bundles with most new 2016 codes.

With 57,161 new edit pairs — roughly 40 percent of which involve services your general surgeon might perform — you need to stay on top of Correct Coding Initiative (CCI) version 22.0 changes that went into effect Jan. 1.

Check out the following summary of CCI changes to make sure your practice is ready to bill correctly in 2016.

Bundle New Codes With ‘Surgical Practice Standards’

Infusions, punctures, blocks, heart/lung monitoring, radiology ... it’s all part of the surgical package, according to Medicare. “That’s why the latest edition of Correct Coding Initiative (CCI), effective January 1, pairs the new CPT^® 2016 surgical codes with most of these ancillary services,” explains Marcella Bucknam, CPC, CPC-I, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, internal audit manager with Peace Health in Vancouver, Wash.

Look for edit pairs that bundle new codes 10035-+10036, 31652-31654, 33447, +37252-+37253, 39401-39402, 47531-47544, 49185 with the following:

• Many closure codes such as 12001-12021 for simple repair, 12031-12057 for intermediate repair, and 13100-13153 for complex repair
• Venipuncture, IV, infusion, or arterial puncture services represented by codes such as 36400-36406, 36420-36440, 36600, and 36640
• Naso- or oro-gastric tube placement (43752)
• Nerve blocks, such as most codes in the range 62310-64530
• Many radiology codes such as 76000-76001, 76942, 76998, 77002, 77011, 77021
• Moderate sedation codes 99148-99150
• Many electrocardiogram (ECG) procedures (93000-93010, 93040-93042)
• Multiple electroencephalography (EEG) services (95812-95822, 95829, 95955)
• Many respiratory assist and monitoring services (94002, 94200, 94250, 94680-94690, 94770)
• Intravenous push and hydration services like 96360-96376
• Most E/M codes

“Note that the bundles for nerve blocks and moderate sedation appear with a modifier indicator of ‘0,’ meaning that you can’t override the edit pairs under any circumstances,” Bucknam cautions.

Pick One Localization Code

In addition to the preceding surgical package restrictions, CCI 22.0 creates other limits on how you can report new codes 10035-+10036 (Placement of soft tissue localization device[s] [e.g., clip, metallic pellet, wire/needle, radioactive seeds], percutaneous, including imaging guidance …). You should not report 10035 or +10036 with any of the following codes for the same procedure:

• 31626 — Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of fiducial markers, single or multiple
• 32553 — Placement of interstitial device(s) for radiation therapy guidance (e.g., fiducial markers, dosimeter), percutaneous, intra-thoracic, single or multiple
• 41019 — Placement of needles, catheters, or other device(s) into the head and/or neck region (percutaneous, transoral, or transnasal) for subsequent interstitial radioelement application
• 49411 — Placement of interstitial device(s) for radiation therapy guidance (e.g., fiducial markers, dosimeter), percutaneous, intra-abdominal, intra-pelvic (except prostate), and/or retroperitoneum, single or multiple

Restrict New EBUS Options

CPT^® 2016 creates three new codes for reporting endobronchial ultrasound (EBUS)-guided lymph node or lesion sampling (31652-+31654, Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed…).

In addition to ancillary surgical procedures, CCI 22.0 also restricts you from billing the new codes with the following procedures:

• 32440-32445 — Removal of lung, pneumonectomy …
• 32480-32491 — Removal of lung, other than pneumonectomy …
• 32501 — Resection and repair of portion of bronchus (bronchoplasty) when performed at time of lobectomy or segmentectomy (List separately in addition to code for primary procedure)
• 32503 -32504 — Resection of apical lung tumor (e.g., Pancoast tumor), including chest wall resection, rib(s) resection(s), neurovascular dissection, when performed …
• 32505-32506 — Thoracotomy  

Watch for More Comprehensive Procedure Bundles

CCI 22.0 adds edit pairs to ensure that you don’t double dip when billing procedures that might include services described by some new codes.

For instance: CCI says you shouldn’t report new code 33477 (Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed) with these codes for more comprehensive valve procedures:

• 33474 — Valvotomy, pulmonary valve, open heart, with cardiopulmonary bypass
• 33475 — Replacement, pulmonary valve

Similarly: You have two new codes for an initial and each subsequent intravascular ultrasound (IVUS) that you’ll report in addition to the primary surgical service (+37252- +37253, Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation …), but you shouldn’t list these new codes in addition to the following, more extensive procedures:

• 37191-37193 — three codes for intravascular vena cava filter insertion, repositioning, and removal (respectively) by endovascular approach
• 37197 — Transcatheter retrieval, percutaneous, of intravascular foreign body (e.g., fractured venous or arterial catheter), includes radiological supervision and interpretation, and imaging guidance (ultrasound or fluoroscopy), when performed

Avoid: If you’re billing for any mediastinum procedures in the range 39000-39220, you should not additionally report new codes 39401 (Mediastinoscopy; includes biopsy[ies] of mediastinal mass [e.g., lymphoma], when performed) or 39402 (…with lymph node biopsy[ies] [e.g., lung cancer staging]), according to CCI 22.0

Bundle sclerotherapy: CPT^® 2016 provides a new code for sclerotherapy (49185, Sclerotherapy of a fluid collection [e.g., lymphocele, cyst, or seroma], percutaneous, including contrast injection[s], sclerosant injection[s], diagnostic study, imaging guidance [e.g., ultrasound, fluoroscopy] and radiological supervision and interpretation when performed). But CCI 22.1 bundles the code with a host of other fluid-collection procedures that you need to know.

For instance: Don’t report 49185 with many codes for any of the following procedures:

Incision and drainage — neck or thorax (21501), oral structures (40800-40801, 41000-41009, 41015-41018, 41800, 42000), throat (42700-42725), pelvic region (45000-45020), liver (47010-47015), and retroperitoneal (49060-49062)

• 32215 — Pleural scarification for repeat pneumothorax
• 32551 — Tube thoracostomy, includes connection to drainage system (eg, water seal), when performed, open (separate procedure)
• 32554-32557 — Thoracentesis, needle or catheter, aspiration of the pleural space …
• 32650 — Thoracoscopy, surgical; with pleurodesis (e.g., mechanical or chemical)
• 36475-36479 — Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency …
• 37242-37244 — Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention…

Remember: If your surgeon performs the 49185 sclerotherapy at a different site or session than any of these bundled procedures, you can override the edit pair using modifier 59 (Distinct procedural service) or other appropriate modifier.