General Surgery Coding Alert

Expect systematic digestive tract changes.

Forewarned is forearmed, so let us take you on a whirlwind tour of what you can expect from 2015 coding changes for your general surgery practice. 

With more than 70 code additions, deletions, and revisions that your surgeon is likely to use, you can’t afford to wait until next January to get to know the code changes. 

Update Intravascular Stent Coding

CPT® 2015 revises 37215-37217 (Transcatheter placement of intravascular stent[s] …) to clean up some wording and clarify that the procedures include angioplasty, when performed, and also include radiological supervision and interpretation.

Along with those revisions, you’ll also have the following new code in the same group:

• 37218 — Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation.

Engage New and Updated Digestive System Codes

The largest number of code revisions and additions you’ll find in CPT® 2015 for your general surgery group comes from the endoscopy codes. “Expect changes from esophagoscopy, to esophagogastroduodenoscopy, to sigmoidoscopy, to colonoscopy, and finally, anoscopy,” says Marcella Bucknam, CPC, CPC-I, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, internal audit manager with PeaceHealth in Vancouver, Wash. 

Standardize wording: The endoscopy code revisions impart uniformity from one section to another, for instance, changing “with removal of foreign body” to “with removal of foreign body(s)” in all the relevant codes. CPT® 2015 also clarifies the language “including collection of specimen(s) by brushing or washing, when performed” in many endoscopy code definitions. 

Expand stent placement, lesion ablation options: Also consistent from small intestine to colon, CPT® 2015 deletes codes for transendoscopic stent placement and lesion ablation, such as 45339 (Sigmoidoscopy, flexible; with ablation of tumor[s], polyp[s], or other lesion[s] not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique) and 45345 (… with transendoscopic stent placement [includes predilation]). 

In place of the deleted codes, CPT® 2015 adds new codes that standardize the code descriptors and are part of a larger group that defines various additional services. For instance, instead of 45339 or 45345, you’ll have the following codes to choose from, beginning Jan. 1, 2015:

• 45346 — Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)
• 45347 — … with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)
• 45349 — … with endoscopic mucosal resection
• 45350 — … with band ligation(s) (e.g., hemorrhoids).

Change Category III codes: Beginning Jan. 1, you’ll have two new anoscopy codes that replace two Category III codes that CPT® 2015 deletes:

• 46601 — Anoscopy; diagnostic, with high-resolution magnification (HRA) (e.g., colposcope, operating microscope) and chemical agent enhancement, including collection of specimen(s) by brushing or washing, when performed
• 46607 — …with high-resolution magnification (HRA) (e.g., colposcope, operating microscope) and chemical agent enhancement, with biopsy, single or multiple.

The deleted Category III codes are as follows:

• 0226T — Anoscopy, high resolution (HRA) (with magnification and chemical agent enhancement); diagnostic, including collection of specimen(s) by brushing or washing when performed
• 0227T — … with biopsy(ies).

Clip and Save for 2015 Reference 

For looking ahead now and for looking back once 2015 rolls in, we’ve created a handy reference tool in the following chart. The table on the next page condenses the most significant CPT® 2015 changes for general surgery coders into one place.