General Surgery Coding Alert

From transnasal EGD to POEM, you’ve got a lot to learn.

Uncharacteristically, most of the CPT^® 2022 news for general surgery practices resides in the Category III section this year. With one surgical “T” code converted to Category I, you’ll also find more than 10 new and revised temporary codes that might impact your practice starting Jan. 1, 2022

Read on for an overview of upcoming CPT^® 2022 changes you need to know, and look to future issues of General Surgery Coding Alert for an in-depth look at how these changes will impact the way you code.

See Relevant Category I Changes

A series of changes in the Musculoskeletal Surgery section impact how you should report nasal-bone fracture treatment. CPT^® 2022 deletes 21310 (Closed treatment of nasal bone fracture without manipulation) and revises the following two codes to add the words, “with manipulation:”

• 21315 (Closed treatment of nasal bone fracture with manipulation; without stabilization)
• 21320 (… with stabilization)

“The changes acknowledge the fact that closed reduction of a nasal bone fracture always involves manipulation,” says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, billing specialty subject matter expert at Kareo in Irvine, Calif.

“If the treatment involves only services such as bleeding control, you should not use one of these surgical codes.

GI updates: You have two new gastrointestinal (GI) codes to learn:

• 42975 (Drug-induced sleep endoscopy, with dynamic evaluation of velum, pharynx, tongue base, and larynx for evaluation of sleep-disordered breathing, flexible, diagnostic)
• 43497 (Lower esophageal myotomy, transoral (ie, peroral endoscopic myotomy [POEM]))

Surgeons may perform POEM to treat achalasia, which is a disorder that makes the movement of liquid and food through the esophagus difficult. During the POEM procedure, physicians use a scope to make an incision in the mid-esophagus and then dissect through the submucosal space and dissect muscle fibers of the lower esophageal sphincter muscle, says Glenn D. Littenberg, MD, MACP, FASGE, AGAF, a gastroenterologist and former CPT^® Editorial Panel member in Pasadena, California.

“This helps relieve the problem of severe dysphagia for food and chest pain that achalasia causes,” he says. “The incision is closed sometimes with clips or endoscopic suturing, and the procedure is similar to what was performed as a ‘Heller myotomy’ by surgeons before the endoscopy technique was developed.” Coders currently report POEM with unlisted code 43499 (Unlisted procedure, esophagus).

CPT^® 2022 also deletes 43850 (Revision of gastroduodenal anastomosis (gastroduodenostomy) with reconstruction; without vagotomy) and 43855 (…with vagotomy).

Capsule endoscopy: New code 91113 (Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), colon, with interpretation and report) replaces deleted code 0355T of the same descriptor.

The code joins three other capsule endoscopy codes for esophagus through ileum imaging (91110), esophagus imaging (91111), or stomach through colon transit and pressure measurement (91112). Plus, CPT^® added 0651T (Magnetically controlled capsule endoscopy, esophagus through stomach, including intraprocedural positioning of capsule, with interpretation and report) in July 2021, which will appear for the first time in the CPT^® 2022 manual.

Mine More Category III Opportunities

Category III represents temporary codes that CPT^® generally archives after five years, either removing the code because of low utilization, or creating a new Category I code for the procedure. You might see them referred to as “T-codes,” because they’re comprised of four digits followed by the letter “T.”

“Because CPT^® uses these codes to gather data, T-codes take priority over unlisted codes: you must use an available Category III code if your surgeon performs that procedure,” Brame-Joy says.

CPT^® 2022 adds the following new codes for procedures general surgeons might perform:

• 0673T (Ablation, benign thyroid nodule(s), percutaneous, laser, including imaging guidance)
• 0700T (Molecular fluorescent imaging of suspicious nevus; first lesion)
• +0701T (… each additional lesion (List separately in addition to code for primary procedure))

Manual addition: CPT^® instituted several relevant Category III codes that became effective July 1, 2021, but will appear for the first time in the CPT^® 2022 manual. You should be aware of the following codes:

Three T-codes for transnasal esophagogastroduodenoscopy (EGD):

• 0652T (Esophagogastroduodenoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure))
• 0653T (… with biopsy, single or multiple)
• 0654T (… with insertion of intraluminal tube or catheter)

Another GI code:

• 0647T (Insertion of gastrostomy tube, percutaneous, with magnetic gastropexy, under ultrasound guidance, image documentation and report)

Wound-study codes:

• 0640T (Noncontact near-infrared spectroscopy studies of flap or wound (eg, for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation [StO2]); image acquisition, interpretation and report, each flap or wound)
• 0641T (… image acquisition only, each flap or wound)
• 0642T (… interpretation and report only, each flap or wound)
• Plus revised code 0493T to indicate “contact” spectroscopy (Contact near-infrared spectroscopy studies of lower extremity wounds (eg, for oxyhemoglobin measurement)