General Surgery Coding Alert

Prep for hernia repair overhaul.

In just three short months you’ll be using CPT^® 2023 to report your general surgery claims, so tune in to this overview of the relevant changes that are coming down the pike.

Key: The AMA hasn’t finalized CPT^® 2023 for publication, so look for more detailed reporting and analysis in upcoming issues of General Surgery Coding Alert. CPT^® 2023 code changes go into effect Jan. 1, 2023.

Expect Lots of Deleted and New Hernia Codes

CPT^® 2023 deletes 18 hernia repair codes for next year. You won’t need to change how you report inguinal, lumbar, or femoral hernia repair, but all other types are on the chopping block.

That means you’ll no longer report the following deleted codes for open hernia repair, beginning Jan. 1:

• 49560-49566 (Repair … incisional or ventral hernia …)
• 49570-49572 (Repair epigastric hernia …)
• 49580-49587 (Repair umbilical hernia …)
• 49590 (Repair spigelian hernia)

Nor will you use the following deleted codes for laparoscopic hernia repair next year:

• 49652-49653 (Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia …)
• 49654-49657 (Laparoscopy, surgical, repair, … incisional hernia …)

“In place of these codes, CPT^® 2023 bundles epigastric, incisional, ventral, umbilical, and spigelian hernia repair, whether open or laparoscopic, into a unified category,” says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, product manager, MRO, in Philadelphia.

For any hernia repair in this new category of “anterior abdominal hernia,” you’ll report one of the 12 new codes. CPT^® 2023 distinguishes these 12 new codes based on initial or recurrent, reducible or incarcerated/strangulated, and repair size, as follows:

• 49591 (Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); less than 3 cm, reducible)
• 49592 (… less than 3 cm, incarcerated or strangulated)
• 49593 (… 3 cm to 10 cm, reducible)
• 49594 (… 3 cm to 10 cm, incarcerated or strangulated)
• 49595 (… greater than 10 cm, reducible)
• 49596 (… greater than 10 cm, incarcerated or strangulated)
• #49613 (Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s); less than 3 cm, reducible)
• 49614 (… less than 3 cm, incarcerated or strangulated)
• 49615 (… 3 cm to 10 cm, reducible)
• 49616 (… 3 cm to 10 cm, incarcerated or strangulated)
• 49617 (… greater than 10 cm, reducible)
• 49618 (… greater than 10 cm, incarcerated or strangulated)

More: Those aren’t the only new hernia codes for 2023, so we’ll dig deeper into hernia coding in future issues of General Surgery Coding Alert.

Look for Big E/M Changes

As with office/outpatient evaluation and management (E/M) codes in 2021, the AMA is changing descriptors for (or outright deleting) several code sets in the other E/M sections of CPT^® 2023. In some cases, these changes mirror what the AMA did in 2021; but there are some differences.

“Overall, the CPT^® Editorial Panel worked to, again, create revisions to the E/M code descriptors and guidelines that met their objective to decrease the administrative burden of excessive documentation whenever possible,” says Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting, Inc. in Lansdale, Pennsylvania.

Look for: Here are some high points of the CPT^® 2023 changes that we’ll cover in detail at a later date:

• Revise descriptor of many E/M codes to delete “3 key components” and replace with “medically appropriate history and/or examination and … level of medical decision making,” similar to 2021 changes to outpatient codes.
• Delete observation codes 99217-99226
• Revise hospital inpatient codes 99221-99239 to include observation
• Revise hospital consultation codes 99252-99255 to include observation
• Delete “domiciliary or rest home” codes 99324-99340 and add “or residence” to home visit codes 99341-99350
• Rework prolonged service codes with deleted, revised, and added codes
• Revise and clarify use of Emergency Department (ED) codes by all physicians

Find Vascular Surgery Changes and More

CPT^® 2023 adds several new codes for vascular surgery procedures. For instance, you’ll find five new codes 33900-+33904 (Percutaneous pulmonary artery revascularization by stent placement …) for pulmonary artery stent placement. The 33900-33903 codes describe various cases for the initial stent, such as normal native or abnormal connections, whether bilateral or unilateral. The final add-on code, +33904, is for “each additional vessel or separate lesion,” which you will report with the appropriate initial code.

You’ll also find the following new codes in the vascular access section:

• 36836 (Percutaneous arteriovenous fistula creation, upper extremity, single access of both the peripheral artery and peripheral vein, including fistula maturation procedures (eg, transluminal balloon angioplasty, coil embolization) when performed, including all vascular access, imaging guidance and radiologic supervision and interpretation)
• 36837 (Percutaneous arteriovenous fistula creation, upper extremity, separate access sites of the peripheral artery and peripheral vein, including fistula maturation procedures (eg, transluminal balloon angioplasty, coil embolization) when performed, including all vascular access, imaging guidance and radiologic supervision and interpretation).