General Surgery Coding Alert

Along with the important changes covered last month, CPT 2003 has added or replaced dozens of codes to improve reporting specificity. These codes describe procedures as diverse as stent placement, apheresis, bone marrow transplants and more, and in some cases will greatly simplify surgeons' and coders' tasks. More Precision for Venipuncture Previously, a single code (36415) described routine venipuncture. For 2003, CPT revises 36415* (Collection of venous blood by venipuncture), removing the words "finger/heel/ear stick" (the procedure now includes only collection of blood via a needle through a vein) and adds 36416 (Collection of capillary blood specimen [e.g., finger, heel, ear stick]) to describe specimens acquired through a simple finger, heel or ear stick. This change may be of special consequence for Medicare (and some private) payers. Because Medicare does not pay for finger/heel/ear sticks, it created its own venipuncture code (G0001) for use in place of 36415, which previously included such sticks. "Now that the AMA differentiates venipuncture from finger, heal and ear sticks, my feeling is that Medicare will drop G0001 and follow CPT," says Kathy Pride, CPC, CCS-P, HIM applications specialist with QuadraMed, which is based in San Rafael, Calif. Watch General Surgery Coding Alert for more information on this topic as it becomes available. An Explosion of Apheresis Codes For 2003, CPT deletes 36520 and 36521, which described apheresis (removing a specific component from the blood and returning it to the donor), and replaces them with six new codes:
36511 Therapeutic apheresis; for white blood cells 36512 for red blood cells 36513 for platelets 36514 for plasma pheresis 36515 with extracorporeal immunoadsorption and plasma reinfusion 36516 with extracorporeal selective adsorption or selective filtration and plasma reinfusion. As explained by the AMA's CPT Changes 2003: An Insider's View, "36520 and 36521 described outdated techniques that were no longer widely used. The new series of CPT codes reflects the current clinical practice and a more specific listing of the various components of the present clinical procedure," thus allowing for more accuracy when tracking the procedural type and frequency. According to CPT Changes, "These procedures may be performed under emergency conditions and may be associated with allergic reactions or other complications requiring physician intervention." Long-Needed Removal of Obstruction Codes Arrive A welcome addition to CPT 2003 are codes to describe removal of obstructive material from central venous devices (for example, fibrin at the distal end of the device or within the lumen), along with codes for the associated imaging procedures:
36536 Mechanical removal of pericatheter obstructive material (e.g., fibrin sheath) from central venous device via separate venous access
75901 Mechanical removal of pericatheter obstructive material (e.g., fibrin sheath) from central venous device via separate venous access, [...]