General Surgery Coding Alert

Plus: 37220-37235 add specificity to your revascularization coding.

CPT 2011 is just around the corner and brings some welcome options for your general surgery practice with more than 35 new and 20 revised codes that could impact your pay.

"Overall, changes demonstrate the 'coding lag' that occurs in keeping up with advances in new surgical procedures," says M. Tray Dunaway, MD, FACS, CSP, a surgeon, author, speaker and coding educator with Healthcare Value, Inc. in Camden, SC.

Get explicit: By adding specificity for new procedures, CPT 2011 can help you miss the unlisted code trap for endovascular and other services, clearing the way for better reporting starting Jan. 1. Let our experts introduce you to changes you can expect for 2011.

Catheter/Interstitial Device Include Imagining Guidance

With seven new and revised codes for catheter insertion and interstitial device placement, CPT 2011 clarifies several aspects of these services.

For instance: "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. "Coders should watch closely for those types of changes."

You'll find three examples of imaging guidance inclusion in the following new and revised codes, along with wording changes that remove "cannula" and specify "tunneled" catheters instead of "permanent":

49324 (revised) -- Laparoscopy, surgical; with insertion of tunneled intraperitoneal cannula or catheter, permanent

49327 (new) -- Laparoscopy, surgical; with placement of interstitial device(s) for radiation therapy guidance (e.g., fiducial markers, dosimeter), intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple (List separately in addition to code for primary procedure)

49412 (new) -- Placement of interstitial device(s) for radiation therapy guidance (e.g., fiducial markers, dosimeter), open, intra-abdominal, intrapelvic, and/or retroperitoneum, including image guidance, if performed, single or multiple (List separately in addition to code for primary procedure)

49418 (new) -- Insertion of tunneled intraperitoneal catheter (e.g., dialysis, intraperitoneal chemotherapy instillation, management of ascites), complete procedure, including imaging guidance, catheter placement, contrast injection when performed, and radiological supervision and interpretation, percutaneous

49419 (revised) -- Insertion of tunneled intraperitoneal cannula or catheter, with subcutaneous reservoir, permanent port (i.e., totally implantable)

49420 (deleted): To report non-tunneled catheter placement, use 49080, which is often bundled

49421 (revised) -- Insertion of tunneled intraperitoneal cannula or catheter for drainage or dialysis, permanent open

49422 (revised) -- Removal of tunneled permanent intraperitoneal cannula or catheter.

Now You Can Capture Specific Intubation and Aspiration

Although your surgeon may perform various intubation and aspiration procedures, you just have one code for the service until Jan 1: 91105 (Gastric intubation, and aspiration or lavage for treatment [e.g., for ingested poisons]). CPT 2011 deletes this code and replaces it with 43753.

New way: CPT 2011 gives you three new codes that distinguish therapeutic and diagnostic gastric tubes:

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)

43755 -- ... collection of multiple fractional specimens with gastric stimulation, single or double lumen tube (gastric secretory study) (e.g., histamine, insulin, pentagastrin, calcium, secretin), includes drug administration.

You'll also find two new codes for duodenal intubation and aspiration:

43756 -- Duodenal intubation and aspiration, diagnostic, includes image guidance; single specimen (e.g., bile study for crystals or afferent loop culture)

43757 -- ... collection of multiple fractional specimens with pancreatic or gallbladder stimulation, single or double lumen tube, includes drug administration.

Update Your Esophagogastric Fundoplasty Coding

You'll find two new specific codes in CPT 2011 for esophagogastric fundoplasty:

43327 -- Esophagogastric fundoplasty partial or complete; laparotomy

43328 -- ... thoracotomy.

"These codes give you specific options when the surgeon performs the procedure through a chest wall or abdominal wall approach," Bucknam says.

Select one of these two codes when the surgeon performs an open esophagogastric complete fundoplication such as Nissen, or partial esophagogastric fundoplasty, such as Belsey or Toupet.

"Note that CPT 2011 deletes 43324 (Esophagogastric fundoplasty [e.g., Nissen, Belsey IV, Hill procedures]) and replaces it with the two new codes 43327 and 43328," Bucknam says.

For a laparoscopic approach, you should continue to use 43280 (Laparoscopy, surgical, esophagogastric fundoplasty [e.g., Nissen, Toupet procedures]).