General Surgery Coding Alert

Get ready for vascular and skin changes, too.

Have you ever been baffled trying to distinguish between an acellular dermal replacement and an acellular dermal allograft? You'll wonder no more, now that CPT 2012 scraps six families of codes in favor of one new skin-substitute-graft family.

We've got a look at these changes and more, so read on for tips on how to code your general surgery claims in 2012.

Distinguish Paracentesis, Lavage

Prior to Jan.1, 2012, abdominal paracentesis and peritoneal lavage shared codes -- meaning that you couldn't distinguish which procedure your surgeon actually performed. Plus, you needed to know whether your surgeon was performing an initial service or a subsequent peritoneal procedure, a fact that was often difficult to ascertain from the surgeon's op note.

CPT® 2012 changes all that by deleting the following codes:

• 49080 -- Peritoneocentisis, abdominal paracentesis, or peritoneal lavage (diagnostic or therapeutic); initial
• 49081 -- ... subsequent,

and replacing them with the following new codes:

• 49082 -- Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance
• 49083 -- ...  with imaging guidance
• 49084 ... Peritoneal lavage, including imaging guidance, when performed.

"You'll use one of these new codes when your surgeon diagnoses or treats a patient with accumulated peritoneal fluid or possible internal bleeding," explains 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.

Open/lap is different: "Remember to use 49084 only for percutaneous lavage," Bucknam says. For open lavage, report 49000 (Exploratory laparotomy, exploratory celiotomy with or without biopsy[s] [separate procedure]) or 49002 (Reopening of recent laparotomy). For laparoscopic lavage, report 49320 (Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]).

Don't miss: "Lavage is bundled into exploration except when performed percutaneously. This is a common mistake and costs general surgery practices thousands of dollars in lost revenue," Bucknam says.

Check Out New Skin Substitute Codes

If you've ever reported your surgeon's skin-substitute grafting, you know how confusing it is to match the skin-substitute product to the proper code family descriptor.

Starting Jan. 1, you'll no longer need to figure out which family describes which skin-substitute product, because CPT® 2012 deletes the following six code families:

• 15170-+15176 -- Acellular dermal replacement ...
• 15300-+15321 -- Allograft skin for temporary wound closure ...
• 15330-+15336 -- Acellular dermal allograft ...
• 15340-+15341 -- Tissue cultured allogeneic skin substitute ...
• 15360-+15366 -- Tissue cultured allogeneic dermal substitute ...
• 15400-+15421 -- Xenograft skin [dermal] for temporary wound closure ...
• 15430-+15431 -- Acellular xenograft implant ...

Instead, you'll choose the appropriate code based on graft location and size using one of the following new CPT® 2012 codes:

• 15271 -- Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq. cm; first 25 sq. cm or less wound surface area
• +15272 -- ... each additional 25 sq. cm wound surface area or part thereof (List separately in addition to code for primary procedure)
• 15273 -- Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq. cm; first 100 sq. cm wound surface area, or 1% of body area of infants and children
• +15274 -- ... each additional 100 sq. cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)
• 15275 -- Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq. cm; first 25 cm or less wound surface area
• +15276 -- ... each additional 25 sq. cm wound surface area, or part thereof (List separately in addition to code for primary procedure)
• 15277 -- Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq. cm; first 100 sq. cm wound surface area, or 1% of body area of infants and children
• +15278 -- ... each additional 100 sq. cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure).

These changes should eliminate a concern addressed at last year's CPT® and RBRVS 2011 Annual Symposium: Apligraf (15340-+15341) has a 90-day global period versus Dermagraft (15360-+15361), which has a 30-day global period, according to Marc Hartstein, deputy director for the Center for Medicare Hospital and Ambulatory Policy Group. That fact created a financial incentive to choose one product over the other -- and the CPT® 2012 changes should eliminate that problem.

There's more: CPT® 2012 also modifies 15150-15157 (Tissue cultured epidermis skin autograft ...), but keeps other autograft codes unchanged (15040-15136).

CPT® 2012 adds new code +15777 (Implantation of biologic implant (e.g., acellular dermal matrix) for soft tissue reinforcement (e.g., breast, trunk) (List separately in addition to code for primary procedure).

"Report +15777 only for soft-tissue surgeries, such as breast -- don't use it for implantation procedures that have their own codes, such as +49568 (Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection [List separately in addition to code for the incisional or ventral hernia repair])," Bucknam cautions.

"You should also not report +15777 when the surgeon uses products like acellular dermal matrix for purposes such as pericardium or meninges repair -- reserve the code for soft tissue," Bucknam emphasizes.

Look for 7 New Vascular Codes

You'll have four new codes beginning Jan. 1 to report selective catheter placement for renal artery and second order or higher renal artery branches (36251-36254). Also expect three new codes for endovascular placement, repositioning, and removal of an intravascular vena cava filter (37191-37193). We'll explore these and more CPT 2012 changes in the next issue of General Surgery Coding Alert.