General Surgery Coding Alert

"Although minimally invasive gastric bypass has been popular for some time now, we have needed to submit the unlisted code," says Suzan Hvizdash, BSJ, CPC, physician education specialist for the department of surgery at UPMC Presbyterian-Shadyside in Pittsburgh. The dedicated codes should make for simpler, timelier and more reliable claims' reimbursement, she says.

And CPT 2005 includes a new open bariatric surgery code, 43845 (Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy [50 to 100 cm common channel] to limit absorption [biliopancreatic diversion with duodenal switch]), that solves the longstanding issue of how to code for these more complex procedures and what all is included in them.

Count the centimeters: You can expect a revision to existing restriction and bypass code 43846 (Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb [150 cm or less] Roux-en-Y gastroenterostomy). The new text changes the definition of a "short limb" to 150 cm or less (previous additions of CPT specified 100 cm or less).

Look for "Roux-en-Y" in the documentation: Code  43846 differs from 43845 "because 43846 involves bypass with a Roux-en-Y. The other code [43845] is a different change to the small bowel," says M. Trayser Dunaway, MD, FACS, a general surgeon in Camden, S.C.

No code for laparoscopic banding: CPT does not contain a new code to describe laparoscopic vertical banding, so you'll have to continue to report this procedure using 43659 (Unlisted laparoscopy procedure, stomach).

Describe 'Partial' Colonoscopy Using 45391/45392

Separately, CPT 2005 boasts two new codes for flexible colonoscopy proximal to the splenic flexure, which include endoscopic ultrasound examination and transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy respectively:

These codes will cover procedures that are more than a flexible sigmoidoscopy but less than a full colonoscopy, Dunaway says.

Often, a surgeon will perform a flexible sigmoid-oscopy using a somewhat longer scope, which allows him to get further into the colon. But he will be unable to get past the splenic flexure. Codes 45391 and 45392 will give the physician credit for getting further than a standard flexible sigmoidoscopy, but not quite a full colonoscopy, Dunaway adds.

You Have Another Choice for GERD

For surgery practices treating gastroesophageal reflux disease (GERD), CPT 2005 has added a new coding option: 43257 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease). This code replaces the previous category III code 0057T, which CPT deletes for 2005.

Although surgeons may have had a difficult time gaining reimbursement for this procedure in the past, a dedicated CPT code could signal more payer acceptance of this treatment technique.

Using an endoscope, the surgeon delivers heat energy to destroy tissue in the problem spots in the lower esophagus sphincter. Either the resulting scar tissue strengthens the muscle or the heat kills the nerves that cause the malfunctioning.

Ease Intestinal Allograft Billing With 44137

You already know to report placement of intestinal allograft using 44135 or 44136 (from a cadaver or living donor, respectively), but now you can also report removal of a previously placed allograft using 44137 (Removal of transplanted intestinal allograft, complete).

Having a dedicated CPT code for a procedure works to everyone's advantage, Hvizdash says.

"Working with multiple surgical specialties, we are continually having to use unlisted-procedure codes and then holding our breath for payment or requests for additional information," Hvizdash says. In contrast, with an established code, "We are able to more accurately set budgets and productive goals, and offer administration better financial reports." She also adds that a dedicated code means you can submit the claim electronically and expect a quicker turn-around and more consistent payment.

Distinguish Hemorrhoidectomy/Hemorrhoidopexy

Not only can patients now choose a less-painful alternative to hemorrhoidectomy, known as hemorrhoidopexy, but you can report the procedure painlessly, too, by using 46947 (Hemorrhoidopexy [e.g., for prolapsing internal hemorrhoids] by stapling).

Look for "stapling" in documentation: This technique does not require that the surgeon remove the hemorrhoidal tissue, as in a typical hemorrhoidectomy. Therefore, coders should be sure to read operative notes carefully to be sure the surgeon specifies "stapling" rather than "excision" of the hemorrhoid(s).

"Hemorrhoid sufferers are often afraid to seek treatment because they are afraid of the pain associated with a hemorrhoidectomy. The interim results indicate that [hemorrhoidopexy] is good news for chronic hemorrhoid sufferers because they now have an effective, less painful option," said Anthony Senagore, MD, a Cleveland Clinic staff surgeon, department of colon and rectal surgery, in a recent American Society of Colon and Rectal Surgeons press release.