Part B Insider (Multispecialty) Coding Alert
Craniectomy And Craniotomy Codes Become Entangled With Edits
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Surgical procedures become more complicated to bill this summer
Anesthesiologists will find it more difficult to bill for injections of retrobulbar medication (67500) with 217 eye procedures after July 1.
Separately, every code in the "twist drill, burr hole(s), or trephine" section (61105-61253) became a component of intercranial neuroendoscopy codes 62161-62165. Almost every one of these edits can be overridden with a modifier.
Craniectomy/craniotomy codes 61322-61323 will become the comprehensive codes for a number of edits. A large number of other craniectomy/cran-iotomy codes will become components of these two. Also, 61322-61323 will become mutually exclusive with craniec-tomy/craniotomy codes 61312-61313.
Neuroendoscopy code 62164 (...with excision of brain tumor, including placement of external ventricular catheter for drainage) became mutually exclusive with craniectomy/ craniotomy codes 61510-61512, 61518-61521, 61526-61530, 61545 and 61575, plus skull base surgery codes 61601, 61606-61608 and 61615-61616.
Sigmoidoscopy codes 45335 and 45340 and colonoscopy codes 45381 and 45386 are exclusive with colorectal screening codes G0104-G0105 and G0121.
Prostate surgery will become more of a minefield in July. Anumber of codes became mutually exclusive with 55866 (Laparoscopy, surgical prostatec-tomy, retropubic radical, including nerve sparing). These are vesical neck and prostate surgery codes 52601 and 52612-52648, prostatectomy codes 55801-55831 and 55859-55865, and 55873 (Cryosurgical ablation of the prostate (includes ultrasonic guidance for interstitial cryosurgical probe placement)).
Two new codes for mechanical removal of obstructive material, 36595-36596, will become mutually exclusive with thromboendarterectomy codes 35301-35311 and postoperative exploration/revision codes 35800-35860.
External carotid artery ligation codes 37600-37609 will become mutually exclusive with endovascu-lar therapy codes 61624-61626, and 37606-37609 will be mutually exclusive with 61623.
Benign tumor excision codes 21046-21049 will have some new components starting July 1. Even though excision codes 21050-21070 are marked as "separate procedure" in the CPT book, they'll be bundled with 21046-21049 soon. So will debridement codes 11010-11012.
Two codes for open reconstructive repair of pectus excavatum or carinatum, 21742-21743, became mutually exclusive with 11010-11012. Also, 21743 became mutually exclusive with 21742.
Unless you have a compelling reason to use a modifier to override them, you'll find that retrobulbar medication is bundled with virtually every surgery in the eyeball section (65091-65850) of the CPTbook, thanks to CCI version 10.2 .
And 21199 (Osteotomy, mandible, with geinoglossus advancement) will be a component of 21046-21047, while 21206 (Osteotomy, maxilla, segmental) will be a component of 21048-21049.
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