General Surgery Coding Alert

G-tube procedure codes also undergo extensive revisions While numerous small tweaks and a few code "renumberings" make up the bulk of CPT changes affecting general surgery practices in the new year, you will also find a number of important, all-new codes for vascular grafts and abdominal tumor excisions, among others. Begin familiarizing yourself with all the changes now so you can transition to the new year without missing a beat -- or filing an outdated claim. Breathe Easy: CPT Revamps Chest Code Changes The lung/pleura surgery portion of CPT gets five new codes -- but they-re not really new, says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPC-OBGYN, CPC-CARDIO, manager of compliance education for the University of Washington Physicians (UWP) and Children's University Medical Group (CUMG) Compliance Program. CPT 2008 simply deletes five codes and replaces them with different codes that have almost exactly the same descriptors: - 32421 -- Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent (replaces 32000) - 32422 -- Thoracentesis with insertion of tube, includes water seal (e.g., for pneumothorax), when performed (separate procedure) (replaces 32002) - 32550 -- Insertion of indwelling tunneled pleural catheter with cuff (replaces 32019) - 32551 -- Tube thoracostomy, includes water seal (e.g., for abscess, hemothorax, empyema), when performed (separate procedure) (replaces 32020) - 32560 -- Chemical pleurodesis (e.g., for recurrent or persistent pneumothorax) (replaces 32005). Descriptors for 32422 and 32551 include slightly different language than their predecessors 32002 and 32020 -- specifically, they include the phrase "includes water seal ... when performed," instead of "with or without water seal" -- but appropriate use of all of the "new" codes will mirror exactly that of previous codes 32000-32020. Take These Cardio Codes to Heart You may find yourself accessing several new grafting codes if your general surgeon specializes in vascular surgery. First among these, 33864 (Ascending aorta graft, with cardiopulmonary bypass with valve suspension, with coronary reconstruction and valve-sparing aortic annulus remodeling [e.g., David procedure, Yacoub procedure]), describes a cutting-edge aortic valve graft procedure known as the Tirone David procedure or the Yacoub procedure. This involves an ascending aorta graft with a cardiopulmonary bypass for valve suspension. It also includes coronary reconstruction and "valve-sparing aortic annulus remodeling." Because the aortic valve is such a complex structure, no valve prosthesis can duplicate its function. Surgeons have developed procedures that either spare the aortic valve or replace it with autologous tissue. CPT 2008 also adds 35523 (Bypass graft, with vein; brachial-ulnar or -radial), which describes a graft not previously given a code. A few additional, non-grafting cardiac codes may affect your practice. For instance, if your surgeon places a wireless physiologic sensor in the aneurismal sac during an endovascular repair, you-ll [...]