Medicare Compliance & Reimbursement

But rectal mucosectomy may have become harder to bill.

It looks as though surgeons can't bill for a colectomy with renal mucosectomy, unless they also performed a protectomy at the same time.

CPT 2007 deletes two codes (44152-44153) for a colectomy without protectomy but with a renal mucosectomy, with or without a loop ileostomy. It replaces those two codes with two new codes, for a colectomy with protectomy, including both loop ileostomy and rectal mucosectomy, when the doctor performs one.

Also, CPT 2007 changes the descriptor for colectomy with protectomy code 44211 to clarify that it includes a rectal mucosecotomy, when the doctor performs one.

"A rectal mucosectomy is time consuming and not everybody does it," says surgeon M. Trayser Dunaway, CEO and chief strategic futurist with Health Care Value in Camden, SC.

More changes: CPT 2007 adds two new laparoscopy codes for insertion and revision of an intraperitoneal cannula or catheter (49324-49325). There are also codes for insertion of a subcutaneous extension to an intraperitoneal cannula or catheter (49435), and a delayed creation of an exit site for an embedded subcutaneous segment (49436).

You'd likely use these when the surgeon creates a ventriculoperitoneal shunt to siphon extra fluid from the patient's brain ventricles into the peritoneum, says Dunaway.

Also, there's a new add-on code for laparoscopic omentopexy (49326), which you'll probably use when the surgeon drags a piece of omentum upwards to cover up an incision and avoid adhesions, says Dunaway. People have been wanting to bill for this extra work for some time, he adds.

GES gets a code: A cutting edge treatment, gastric electro stimulation (GES), has two new codes, for laparoscopic (43647-43648) implantation/replacement or revision/removal. Another duo covers the same procedures, only open (43881-43882).

In 1999, the Food & Drug Administration approved a GES system called Enterra to treat gastroparesis, which is a disorder in which food moves too slowly through the stomach. Approximately 20 percent of people with type 1 diabetes will develop gastroparesis in their lifetime, according to Sutter Health, which provides GES.

Until now, you've had to use code 64999 (unlisted procedure, nervous system) along with upper GI endoscopy code 43235, neurostimulator insertion code 64590 and electronic analysis code 95970. Having four specific GES codes will make this service much easier to bill for, coding sources say.