General Surgery Coding Alert

Include standard surgical services, radiology, in single surgical code.

Just about the time you're done prepping to use the new CPT 2011 general surgery codes, the latest edition of Medicare's Correct Coding Initiative (CCI) is already making some code pairings impossible.

CCI released version 17.0, effective Jan. 1, revealing 19,822 new active pairs and 9,778 code pair deletions, according to Frank D. Cohen, MPA, MBB, senior analyst with Frank Cohen Group, LLC.

Most of the code pairings affect codes that debuted or exited in CPT 2011. But a new focus on bundling radiology with surgical procedures leads to a host of new edit pairs, too. Make sure you're familiar with all the general surgery edits you need to know with just three expert tips.

Tip 1: Don't Unbundle Standard Surgical Services

Medicare specifies that when you bill a surgical code, the procedure includes all intraoperative services that are usual and necessary parts of the surgery. That's why CCI 17.0 lists "standards of medical/surgical practice," as the reason for more than 1000 new code pairs with new CPT 2011 general surgery codes 37220-37235 (Revascularization, endovascular, open or percutaneous, ...)

Know the column 2 codes: With the above new surgical codes as column 1 codes, CCI 17.0 creates edit pairs with the following procedures that Medicare considers usual and necessary parts of surgery:

You should study these bundles carefully, because CCI assigns many of the new edit pairs a "0" modifier indicator, meaning that you cannot override the edit pair under any circumstances.

Tip 2: Heed Thousands of Radiology Bundles

Several revised CPT 2011 general surgery codes debut in CCI 17.0 bundled with radiology services. You'll find the following new codes bundled with 76000-76001 (Fluoroscopy ...) and +77001 (Fluoroscopic guidance for central venous access device placement, replacement ...):

CPT 2011 corroborates the fluoroscopic guidance bundles by adding a text note that states, "Do not report guidance codes 77001, 77002, 77003 for services in which fluoroscopic guidance is included in the descriptor."

Look for ultrasound bundles: CCI 17.0 also bundles revised CPT 2011 code 35526 (Bypass graft, with vein; aortosubclavian, aortoinnominate, or aortocarotid) with new ultrasound codes 76881 (Ultrasound, extremity, nonvascular, real-time with image documentation; complete) and 76882 (... limited, anatomic specific).

That's not all: New and revised CPT codes don't account for the vast majority of new CCI 17.0 radiology edit pairs. You'll find over 12,000 new bundles with 76000-76001, 76881-76882, and 77000-77003.

"This large number of new radiology edit pairs is part of the previous pattern of bundling ancillary services that are typically part of procedures, including radiological guidance," 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. "Coders should watch closely for those types of changes."

Silver lining: "I have not typically seen these fluoroscopic guidance procedures performed by general surgeons, but it is possible," says Bucknam. Typically, interventional radiologists would be coding these procedures instead of your general surgeon.

Tip 3: 'Mutually Exclusive' Restricts New Code Families

Make sure you pick only one, "most specific" code to describe a single procedure -- that's the message of several new CCI 17.0 mutually exclusive edit pairs.

For instance: CCI 17.0 bundles new codes 43227 (Esophagogastric fundoplasty partial or complet5e; laparotomy) and 43328 (... thoracotomy) with 43325 (Esophagogastric fundoplasty, with fundic patch [Thal-Nissen procedure]) and 43405 (Ligation or stapling at gastroesophageal junction for pre-existing esophageal perforation).

Similarly, CCI 17.0 bundles 43752 (Naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance [includes fluoroscopy, image documentation, and report]) with the following new codes:

Use modifier for separate sessions or sites: These new edit pairs are on CCI's "mutually exclusive" list, meaning that your surgeon would be very unlikely to perform both bundled procedures because they provide similar services by different methodologies or approaches.

If the surgeon performs truly distinct procedures at a different site or surgical session, however, you can override the edit pair by appending modifier 59 (Distinct procedural service).