General Surgery Coding Alert

Look for more fluid collection edit pairs, too.

Some specialties get a break in the second quarter Correct Coding Initiative (CCI) update — but not general surgery. More than 10 percent of the new edit pairs are for surgical procedures that physicians in your practice might perform. 

How big is it? Relative to the CCI 20.0 update of 61,120 new edit pairs, the version 20.1 list looks small, with only 4,322 new bundles. “Overall, it’s a bit of a yawn this time,” says Frank Cohen, MPA, MBB, principal and senior analyst for The Frank Cohen Group in Clearwater, Fla. 

Don’t be fooled: Despite a relatively small update, you should read on, because you can’t afford to miss nearly 500 new CCI bundles that could impact your general surgery coding and billing.

Refresher: If you’re not familiar with CCI edits, here’s how it works. “All edits consist of code pairs that are arranged in two columns (Column 1 and Column 2),”explains Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, of MJH Consulting in Denver. “Codes that are listed in Column 2 are not payable if performed on the same day on the same patient by the same provider as the code listed in Column 1, unless the edits permit the use of a modifier associated with CCI.” 

Apply New Fluid Collection Bundles

CPT® 2014 added four codes for image guided catheter drainage, and despite adding plenty of edit pairs for these codes at the first of this year, CCI 20.1 creates additional limitations on how you can use the following new codes:

• 10030 — Image-guided fluid collection drainage by catheter (e.g., abscess, hematoma, seroma, lymphocele, cyst), soft tissue (e.g., extremity, abdominal wall, neck), percutaneous
• 49405 -49407— Image-guided fluid collection drainage by catheter (e.g., abscess, hematoma, seroma, lymphocele, cyst); … for visceral, percutaneous peritoneal, or transvaginal/transrectal sites.

CCI 20.1: The new edit pairs mean that you shouldn’t report 10030 with any of the following procedures for the same drainage site:

• 10060-10061 — Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); …
• 10080-10081 — Incision and drainage of pilonidal cyst;…
• 10140 — Incision and drainage of hematoma, seroma or fluid collection
• 10160 — Puncture aspiration of abscess, hematoma, bulla, or cyst

Nor should you report 49405 with the following codes for the same fluid collection procedure from the viscera:

• 47490 — Cholecystostomy, percutaneous, complete procedure, including imaging guidance, catheter placement, cholecystogram when performed, and radiological supervision and interpretation
• 32554-32555 — Thoracentesis, needle or catheter, aspiration of the pleural space;…
• 32556-32557 — Pleural drainage, percutaneous, with insertion of indwelling catheter;…

And new edit pairs for 49406 and 49407 mean that you shouldn’t report either of those codes with the following:

• 49082-49083 — Abdominal paracentesis (diagnostic or therapeutic); …
• 49084 — Peritoneal lavage, including imaging guidance, when performed

For each of these edit pairs, you should choose and report the single code that most specifically describes the procedure your surgeon performs. 

Coder tip: Because all of the preceding edit pairs have a modifier indicator of “1,” you can override the edit pair by appending modifier 59 (Distinct procedural service) to the column 2 code if your surgeon performs two of the bundled procedures at different surgical sites or at different operative sessions.

Pick One Vascular Procedure

If you’re using the four new CPT® 2014 codes for vascular embolization in your practice (37241-37244, Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; …), you should know that CCI 20.1 bundles them with the following procedures:

• 36468-36469 — Single or multiple injections of sclerosing solutions, spider veins (telangiectasia); …
• 36470-36471 — Injection of sclerosing solution; …
• 36475-+36476 — Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; …
• 36478-+36479 — Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; …

Caution: Unlike the edit pairs for the drainage codes, CCI lists these vascular procedure bundles with a modifier indicator of “0,” meaning that you cannot override the edit pairs under any circumstances. 

Esophagus Code Overhaul Means CCI Overload 

The bulk of the new CCI 20.1 edit pairs that impact your general surgery practice come from the esophageal surgery section in CPT®. 

Remember: CPT® 2014 ushered in a major overhaul of the esophagus section, creating the following new or revised codes:

• 27 new and revised codes in the range 43191-43232 for esophagoscopy. CPT® distinguishes the codes on the basis of approach (such as transnasal or transoral), whether the surgeon uses a flexible or rigid scope, and what additional services are included (such as biopsy or injection)
• 26 revised and new codes in the range 43235-43259 (plus 43233, 43266, and 43270 out of numerical sequence) for esophagogastroduodenoscopy. Similar to 43191-43232, details of the service distinguish the codes.
• 10 revised and new codes in the range 43260-43273 (plus 43274, 43275, 43277, and 43278 out of numerical sequence) for endoscopic retrograde cholangiopancreatography (ERCP). 

CCI 20.1 adds approximately 400 new edit pairs with these codes. Most of the bundles ensure that you choose only the most specific code for your endoscopic esophageal surgery, and don’t double up on codes within this vast section of new and revised codes from 43191 to 43278.

Additionally, CCI bundles some of the preceding codes with 43450-43453 (Dilation of esophagus …).

CCI means it: Because most of these 400 edit pairs have a modifier indicator of “0,” you can’t override the bundles using a modifier. Instead, you’ll need to ensure that you select the most accurate single code based on your surgeon’s documentation.