General Surgery Coding Alert

Version 7.2 of the national Correct Coding Initiative (CCI), effective July 1, includes many edits of interest to general surgeons. Of particular note are changes for the following five procedures, which are now bundled with hundreds of other codes:

49000 -- exploratory laparotomy, exploratory celiotomy with or without biopsy(s)(separate procedure)

49002 -- reopening of recent laparotomy
 
44200 -- laparoscopy, surgical; enterolysis (freeing of intestinal adhesion)(separate procedure)
 
G0168 -- wound closure utilizing tissue adhesive(s) only
 
97601 -- removal of devitalized tissue from wound; selective debridement, without  anesthesia (e.g., high pressure waterjet, sharp selective debridement with scissors, scalpel and tweezers), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session.  
These codes, otherwise unrelated, all describe a service usually considered incidental when performed with another, more extensive procedure. By making hundreds of code combinations involving these procedures explicitly nonpayable, CCI is reinforcing widely accepted (but in some cases, poorly understood) coding conventions.
44200: Separate Procedures Are Usually Bundled  
Any CPT-designated "separate procedure" can normally be billed when it is the only procedure performed. For instance, 44200 is included in any more extensive procedure -- laparoscopic or open -- during the same operative session.
 
Note: This rule does not apply to entirely unrelated procedures (for example, procedures in a different body area). In such cases, append 44200, for instance, with modifier -59 (distinct procedural service) to indicate the procedures are separate and should not be bundled.
 
Version 7.2 bundles 44200 to more than 300 codes, of which most are surgery codes in the digestive or genitourinary sections (40000 and 50000 series, respectively) of CPT. Although separate-procedure status is one of the criteria by which CCI bundles codes, not all CPT-designated separate procedures are bundled. As with 44200 in this case, however, individual edits involving the CPT-defined separate procedure are often added to subsequent versions of the CCI.
 
Most of the 300+ codes that now bundle 44200 describe open procedures, notes Kathleen Mueller, RN, CPC, CCS-P, an independent general surgery coding and reimbursement specialist in Lenzburg, Ill. "Laparoscopic lysis of adhesions, like open lysis of adhesions [44005], was already bundled with lap choles [47562] and most other laparoscopic abdominal procedures -- as well as open cholecystectomy. But not all open procedures were bundled, and some surgeons tried to bill for lysing the adhesions laparoscopically after converting the primary procedure to an open chole," Mueller says. She notes that such claims, even if paid, would almost certainly be noticed during a subsequent audit. "Formally bundling 44200 to these codes addresses this issue head-on."  
 
CCI regularly issues new edits to reinforce existing coding guidelines, conventions and principles, Mueller agrees. She notes that until an earlier version of the CCI bundled 44200 to laparoscopic procedures, laparoscopic lysis of adhesions was (technically) separately payable when performed, for example, during [...]