General Surgery Coding Alert

Clarify billing for radiological guidance.

When your general surgeon placed interstitial devices for radiation therapy guidance during a distinct open or laparoscopic abdominal procedure, you didn't have a way to code the additional service -- until now. Make sure you capture all the pay you deserve when you learn how to use two new CPT 2011 codes for the procedure.

Open, Lap, or Percutaneous Approach Distinguish Placement

Last year, you had one code to use when your surgeon placed an abdominal interstitial device for radiation therapy guidance -- 49411 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], percutaneous, intra-abdominal, intra-pelvic [except prostate], and/or retroperitoneum, single or multiple).

"If your surgeon performed the device placement during an open or laparoscopic procedure prior to 2011, you had no way to capture the service," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program in Seattle.

Now CPT 2011 adds two new add-on codes to describe interstitial device placement during another procedure, as follows:

• +49327 -- Laparoscopy, surgical; with placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple [List separately in addition to code for primary procedure])
• +49412 -- Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], open, intra-abdominal, intrapelvic, and/or retroperitoneum, including image guidance, if performed, single or multiple [List separately in addition to code for primary procedure]).

Choose +49327 for a laparoscopic approach, and +49412 for an open procedure. "Note that these are add-on codes, which means you can report them only in addition to a primary procedure," Bucknam advises.

Continue to report 49411 for percutaneous interstitial device placement as a stand-alone procedure.

Know Your Anatomy

Use codes 49411, +49412, and +49327 for procedures in the abdominal, pelvic, or retroperitoneal areas.

Exception: CPT provides a distinct code for prostate (55876, Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], , prostate, (via needle, any approach) single or multiple), so you should use the most specific code.

Don't report 55876 plus an abdominal code for the same service. Correct Coding Initiative (CCI) edits prohibit reporting 55876 with +49327 with a modifier indicator of "0," meaning that you cannot override the edit pair.

"When indicated, you will use + 49327 in conjunction with laparoscopic abdominal, pelvic, or retroperitoneal procedure(s) performed concurrently," explains Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook, New York.

Separate regions earn different codes: Other codes describe interstitial device placement for other body regions, such as 32553 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers,dosimeter], percutaneous, intra-thoracic, single or multiple).

Watch for Imaging Guidance

Despite CPT's pattern of bundling typical ancillary services with procedures, you should continue to separately report imaging guidance with 49411, if performed. A text note following 49411 states, "For imaging guidance, see 76942, 77002, 77012, 77021."

On the other hand, +49327 and +49412 include image guidance, if performed, based on the code definitions.