General Surgery Coding Alert

Stay compliant with claims-filing rules.

With loads of new CPT^® codes effective in January, you can always expect loads of new Correct Coding Initiative (CCI) procedure-to-procedure (PTP) edits to guide your coding in the New Year. This year is no different, so we have the low down on some CCI bundles you need to know.

Remember: CMS reviews and revises PTP edits on a quarterly basis, and this data is usually available several weeks before the start of a new quarter, according to Ruby Woodward, BSN, CPC, CPMA, CPB, COSC, CSFAC, CPC-I, coding and compliance manager at Suburban Imaging/Suburban Radiologic Consultants in Minneapolis, Minnesota. "I strongly recommend not relying on memory and always checking the edits when submitting claims for multiple services on the same date of service," she says.

Come to Grips With All-Encompassing Endovascular Edits

You've got a slew of edits to learn involving the new, all-encompassing endovascular codes 34701-34708. These codes describe various distinct methods for endovascular repair of infrarenal aorta and/or iliac artery(ies).

Some of the codes bundled into new codes 34701-34708 include the following:

• 34710 and +34711 (Delayed placement of distal or proximal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, endoleak, or endograft migration, ...)
• 34841-34844 (Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft ...)
• 34845 and 34846 (Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal aortic endograft ...)
• +69990 (Microsurgical techniques, requiring use of operating microscope ...).

These edits cannot be broken under any circumstances because they have a modifier indicator of "0."

On the other hand: Some of the codes bundled into 34701-34708 with a modifier indicator of "1" include:

• 12004-12007 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet)...)
• 12034-12036 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet)...)
• 13100-+13102 (Repair, complex, trunk...)
• 93040-93042 (Rhythm ECG, 1-3 leads...)
• 96365-+96368 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug)...).

The modifier indicator of "1" means that you can override these edits, if appropriate, by using a modifier such as modifier 59 (Distinct procedural service), according to Mary I. Falbo, MBA, CPC, president and CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania.

Examine These Extension Prosthesis Placement Edits

Make sure to learn the numerous edits surrounding new extension prosthesis placement codes +34709 (Placement of extension prosthesis(es) distal to the common iliac artery(ies) or proximal to the renal artery(ies) for endovascular repair of infrarenal abdominal aortic ...) through +34711 (Delayed placement of distal or proximal extension prosthesis for endovascular repair of infrarenal abdominal ...).

For example, you'll find new bundles with a modifier indicator of "0" for 34710 (Delayed placement of distal or proximal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, endoleak, or endograft migration, ...) with endovascular repair codes 34841-34848 and new codes 34701-+ 34709.

Codes bundled with 34710 with a modifier indicator of "1" include the following:

• Simple wound repair codes 12007, 12011, 12013-12018
• Superficial wound dehiscence treatment codes 12020 and 12021.

Break Down These Delivery to Endograft, Endo Prosthesis Edit Additions

CPT^® 2018 adds new codes 34712 (Transcatheter delivery of enhanced fixation device(s) to the endograft ...) through +34716 (Open axillary/subclavian artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass ...) to describe delivery of endovascular prosthesis.

For instance: CCI bundles simple wound repair codes 12004-12007, 12011, and 12013-12018 and direct repair of aneurysm, pseudoaneurysm, or excision codes 35011, 35013, 35045, and 35081 with +34715 (Open axillary/subclavian artery exposure for delivery of endovascular prosthesis by infraclavicular or supraclavicular incision, unilateral ...). Although you can override these edits, when appropriate, you can't unbundle edits for operating microscope code +69990 and arterial pressure waveform analysis code 93050 with +34715, because those edit pairs have a "0" modifier indicator.

Editor's note: These edits are just a sample of what you should be aware of surrounding the 2018 surgery updates - not an exhaustive list. Visit www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Version_Update_Changes.html for the complete list of CCI 24.0edits.