General Surgery Coding Alert

National Technical Information Services (NTIS) has released version 8.2 of the national Correct Coding Initiative (CCI), which lists over 17,000 code-pair additions (new edits) and 3,700 code-pair deletions. The third-quarter revision for 2002 takes effect July 1 and contains relatively minor changes aimed at general surgery, thus allowing surgeons and their coders to breathe easy this quarter. What's New?

The few additions to the mutually exclusive code-pair edits (those procedures that, according to CCI, "cannot reasonably be done in the same session," e.g., two different repair methods for the same organ) occur exclusively in the 49xxx code range (Surgery; abdomen, peritoneum, and omentum).

For example, codes 49200 and 49201 for excision or destruction of intra-abdominal or retroperitoneal tumors or cysts now include as mutually exclusive 47380 (Ablation, open, of one or more liver tumor[s]; radiofrequency) and 47381 ( cryosurgical).

And hernia repair codes 49505-49525 are deemed exclusive of every other hernia repair code in the range 49491-49521. Therefore, 49505 excludes 49491, 49492, 49495, 49496, 49500, 49501, 49507, 49520 and 49521. Similarly, 49507 excludes 49491, 49492, 49495, 49496, 49500, 49501, 49505, 49520 and 49521. The same pattern applies for 49520, 49521 and 49525.

Additions to the comprehensive/component code edits (also called "correct coding" edits) occur across a wider range of applicable codes. In many cases the edits bundle (i.e., include as not separately reportable) anesthesia procedures to surgical procedures for instance, anesthesia codes 00400 and 01995 are bundled to virtually all debridement and excision codes in the 11040-11626 range. But because the general surgeon would not report anesthesia codes in any event, these edits are of little interest. More significantly, endovascular repair codes 34800-34804 now bundle aortography, 75625 and 75630. Also, predictably, a number of procedures newly bundle use of microsurgical techniques (69990), including 35647, 36002, 36820, 43313, 43314, 44126, 44127, 44204, 44205, 45136, 46020, 47370, 47371, 47380, 47381, 49491 and 49492. This continues the trend whereby use of the operating microscope is separately reportable for fewer and fewer procedures. Enterectomy/enteroenterostomy codes 44120 and 44125-44130 now include 50715 (Ureterolysis, with or without repositioning of ureter for retroperitoneal fibrosis). Colectomy procedures 44140-44160 also now bundle 50715, as well as partial colectomy with anastomosis or removal of terminal ileum (44204 and 44205, respectively). Note: Additional codes to bundle 50715 now include 44602, 44604, 44660, 49200 and 49201. Code 44204 now includes its parent code, 44200 (Laparoscopy, surgical; enterolysis [freeing of intestinal adhesion] [separate procedure]). Code 44205 also includes 44200, 44202 (... enterectomy, resection of small intestine, single resection and anastomosis) and all codes in the enterostomy range (44300-44346). Comprehensive code 45126 (Pelvic exenteration for colorectal malignancy ) includes as components dilation and curettage and hysteroscopy procedures 58120 and 58558. Of all the new edits discussed, [...]