General Surgery Coding Alert

With more than 10,000 changes in the latest National Correct Coding Initiative quarterly update (version 12.1, effective April 1), you could spend an entire month trying to determine how the edits will affect you.

Or you could simply look below for the most important additions and deletions.

Modifiers Can't Save Wound Care Bundles

Active wound care management codes 97602-97606 became components of 556 different codes on April 1, including many codes from the integumentary system surgery section. The same procedures also became components of many lesion destruction, replantation and amputation codes, among others.

You can use a modifier (such as modifier 59, Distinct procedural service) to override almost all of these edits, however, if you provide wound care in a separate location (that is, not as a part of the more extensive procedure).

Codes 97602-97606 also become mutually exclusive with debridement codes 11000, 11010-11012 and CPT 11720 -11721, and burn treatment codes 16000-16035. You can override these edits with a modifier, as well.

Bottom line: In most cases that your practice might provide negative-pressure wound therapy, you-ll no longer be able to report these services for Medicare payers.

No surprises: Carriers are already denying claims for negative-pressure wound therapy codes 97605-97606 along with a debridement, says Suzan Hvizdash, BSJ, CPC, physician education specialist for the department of surgery at UPMC Presbyterian-Shadyside in Pittsburgh and an American Academy of Professional Coders National Advisory Board member.

Some good news: You will be able to use a modifier to override edits that make anesthetic injection codes 64400-64470, 64475, 64479 and 64483 components of 97602-97606. You-ll also be able to override edits making injection codes 90772 and 90774-90775 components of codes 97602-97606.

Surgeons don't usually perform negative-pressure wound therapy with anesthesia in the office, Hvizdash says. In the operating room, there are separate providers billing for wound therapy and anesthesia. Surgeons will use anesthesia when the wound is deep or painful, and CMS should pay for it separately, she says.

Debridements Now Include I&D

You should also be on the lookout for new bundles involving excision and debridement codes 11004-11006. Specifically, these codes now include:

- excisions and debridements 11000 and 11010-11044
- abscess incision and drainage 10060-10061
- trigger point injections 20552-20553.

More good news: NCCI 12.1 deletes one set of formerly troublesome edits. Starting in April, lesion excision codes 11600-11646 will no longer be components of tissue transfer or rearrangement codes 14000-14300. Therefore, you will be able to report these procedures separately without using a modifier of any type.

Hemorrhoid Codes Hit With Unbeatable Edits

NCCI 12.1 also designates 10 digestive surgery codes (manipulation 45900-45910, incision 46040 and 46080, excisions 46220-46221, anoscopy 46600, and destruction 46940-46942) as components of hemorrhoidopexy (46947, Hemorrhoidopexy [e.g., for prolapsing internal hemorrhoids] by stapling).

Code 46947, meanwhile, becomes mutually exclusive with 46500 (Injection of sclerosing solution, hemorrhoids), but you can override that edit with a modifier. Code 46947 is also mutually exclusive with hemorrhoid destruction (46934-46936). No modifier will help you to overcome these edits.

Learn more: For complete information on 46947, see -Hemorrhoidopexy Brings Relief, Documentation Challenges- in the March 2005 General Surgery Coding Alert on page 20.