Part B Insider (Multispecialty) Coding Alert

Published on Sat Dec 09, 2006 PDF

CMS makes new code 15830 carrier-priced

Perhaps you were hoping for a new era of streamlined abdominoplasty reimbursement when CPT 2007 introduced two new codes. Instead, you-ll have more hassles than ever.

CPT 2007 deleted abdominoplasty code 15831 and replaced it with two new codes for excision of excessive skin from the abdomen: 15830 and 15847 (an add-on code). Now, CMS says it wants to make both codes -restricted- codes with an -R- indicator, meaning you-ll have to submit extra documentation with the claim to get paid.

The RVU Update Committee (RUC) had proposed 15.60 work RVUs for 15830, but CMS decided to make it carrier-priced. In a set of corrections to the 2007 physician fee schedule, CMS noted that the RUC had recommended making add-on code 15847 carrier-priced to cut down on the possibility of abuse. CMS opted to make both codes -R- codes and have carriers set prices for them.

It was already a nightmare to obtain payment for the old code, 15831, according to coder Pat McCullough with Reading Hospital in West Reading, PA. Providers had to submit supporting documentation to carriers and prove that the abdominoplasty wasn't a cosmetic procedure.

McCullough's surgeons will usually bill 15831 for patients who have large hernias -with skin and subcutaneous breakdown of a large pannus.- McCullough will submit office notes and op notes that document the non-healing condition of the pannus, and the accompanying inflammation. The add-on code, 15847, would be helpful in this instance, McCullough says.

Even the RUC's suggested RVU rate for 15831, 15.60 work RVUs, was lower than the 22.31 work RVUs that 15830 had, McCullough protests. -With these cases there is a lot of intensive work both intra-operatively and post operatively- because patients requiring these surgeries often have weight issues and co-morbidities, such as diabetes, McCullough adds.

Warning: With abdominoplasties that genuinely are cosmetic, you-ll have a hard time obtaining any payment from carriers, says coder Karen Godfrey with Yellowstone Neurosurgical Associates in Billings, MT.

The fee schedule correction also makes minor corrections to the physician work RVUs for dozens of codes. It alters a number of technical elements about various codes as well. You can view it online at http://tinyurl.com/y3abvw.