Gastroenterology Coding Alert

The newest Correct Coding Initiative (CCI) version (8.2) confirms many obvious coding inaccuracies dealing with hernia, anesthesia and microscopy codes. The edits, which are effective July 1, 2002, leave gastroenterology practices rather untouched.

Several hernia repair codes can no longer be reported with other hernia codes. Codes 49505 (Repair initial inguinal hernia, age 5 years or over; reducible) and 49507 ( incarcerated or strangulated) are mutually exclusive of 49491 (Repair, initial inguinal hernia, preterm infant [less than 37 weeks gestation at birth], performed from birth up to 50 weeks post-conceptual age, with or without hydrocelectomy; reducible) and 49492 ( incarcerated or strangulated).

"Mutually exclusive codes represent procedures or services that could not reasonably be performed at the same session by the same provider on the same beneficiary," CCI explains. Because the codes describe specific ages, an older patient (49505-49507) or a younger patient (49491-49492), obviously both codes could not be reported together.

Similarly, 49520 (Repair recurrent inguinal hernia, any age; reducible) and 49525 (Repair inguinal hernia, sliding, any age) should not be reported with 49491-49492. In addition, CCI 8.2 makes 49520 and 49521 ( incarcerated or strangulated) mutually exclusive. Code 49525 should not be used with 49496 (Repair, initial inguinal hernia, full term infant under age 6 months, or preterm infant over 50 weeks postconceptual age and under age 6 months at the time of surgery, with or without hydroc-electomy; incarcerated or strangulated), 49501 (Repair initial inguinal hernia, age 6 months to under 5 years, with or without hydrocelectomy; incarcerated or strangulated), 49507 or 49521.

Gastroenterologists should note that all the codes in the endoscopy (43200-43259) and ERCP (endoscopic retrograde cholangiopancreatography, 43260-43272) series now include anesthesia code 00520 (Anesthesia for closed chest procedures; [including bronchoscopy]). Laparoscopy code 43280 also bundles anesthesia (00520) in the surgical procedure.

CCI 8.2 makes anesthesia a component of numerous other codes. For instance, revision of ileostomy (44312-44314) and colostomy (44340-44346) incorporates anesthesia code 00840 (Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified). Code 00902 (Anesthesia for; anorectal procedure) is now bundled with all procedures in the anus section (46030-46946) and placement of seton code (46020).

Anesthesia code 00740 (Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum) should not be used with colonoscopy codes (45378-45387), because it is a misuse of 00740, according to CCI 8.2. In a parallel ruling, CCI says reporting 43200-43272 with 00810 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum) is inappropriate.

However, these edits should come as no surprise to gastroenterologists. CPT defines anesthesia codes as time-based codes. CPT Assistant, February 1997, states, "Do not code procedural services with anesthesia coding guidelines." If a surgeon performs the service, he or she can report the anesthesia with the appropriate surgical code appended with modifier -47 (Anesthesia by surgeon). With these edits, CCI is simply reinforcing CPT coding conventions.

CCI 8.2 limits the role of the operating microscope (+69990, Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]). The edits state that reporting 69990 with the following codes is a misuse: esophago-plasty (43313-43314), enterectomy (44126-44127), laparoscopy for colectomy (44204-44205) and liver (47370-47371), excision of ileoanal reservoir (45136), placement of seton (46020), ablation of liver tumor(s) (47380-47381) and intraperitoneal catheter codes (49421-49422). CPT 2002 introduced all the affected microscopy codes except for 49421-49422.

The edits clarify that the procedures do not necessitate a "surgical operating microscope used to obtain good visualization of fine structures in the operating field" (CPT's definition of an operating microscope).