General Surgery Coding Alert

Pull out the red pen to correct a dangerous error in your manual.

With a 2011 code revision, 47490 joined the ranks of "complete" surgical codes -- meaning the encounter requires just one code to represent the procedure and related radiology services. Read on for important information on why CPT revised this code and how you're expected to use it.

See What Updated 47490 Includes to Earn $365

CPT 2011 revised 47490 so that it now represents the "complete" service required for percutaneous creation of an opening in the gallbladder:

• 2010: 47490 -- Percutaneous cholecystostomy
• 2011: 47490 -- Cholecystostomy, percutaneous, complete procedure, including imaging guidance, catheter placement, cholecystogram when performed, and radiological supervision and interpretation.

Percutaneous cholecystostomy is a life-saving procedure used to buy time for patients who are too ill to undergo gallbladder removal, noted presenter Geraldine McGinty, MD, MBA, representing the American College of Radiology at the AMA's CPT and RBRVS 2011 Annual Symposium.

Medicare's national rate for 47490 runs around $365, and CMS assigned the code a 10-day global period. That means related E/M services on the day of the procedure (following decision for surgery) and for the 10 days following the procedure aren't payable separately. In fact, two post-procedure visits are factored into the fee, McGinty stated in her presentation.

Don't Unbundle Radiological Guidance

Code 47490 isn't the only one for this new "inclusive" emphasis. "CPT is continuing their previous pattern of bundling the ancillary services that are typically part of procedures, including radiological guidance," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program in Seattle.

As part of the change to a "complete" code, CPT 2011 adds a note with 47490 telling you not to report the code with 47505 (Injection procedure for cholangiography ...) or with radiology codes 74305, 75989, 76942, 77002, 77012, and 77021.

Caution: You may find that your CPT manual contradicts itself in the notes under 47490. As mentioned above, the manual states you should not report 47490 with 75989 (Radiological guidance [i.e., fluoroscopy, ultrasound, or computed tomography], for percutaneous drainage [e.g., abscess, specimen collection], with placement of catheter, radiological supervision and interpretation). But immediately under that, many manuals have the line, "For radiological supervision and interpretation, use 75989."

Strike through: That last sentence was printed erroneously in CPT 2011, according to AMA's published errata. To correct this inaccuracy, delete the information directing you to report 75989 for radiological supervision.

Keep Up with Errata

The AMA provides interim corrections to the published CPT® manual. You can check for updates at the AMA Web site, www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/about-cpt/errata.page.

Other current corrections that could impact your surgery practice involve a note following 49419 (Insertion of tunneled intraperitoneal catheter, with subcutaneous port [i.e., totally implantable]). The correction directs coders to 49020-49081 (Drainage ... or Peritoneocentesis...) for open or percutaneous peritoneal drainage or lavage.