General Surgery Coding Alert

Among the approximately 40,000 revisions in version 9.0 of the Correct Coding Initiative (CCI) are several thousand new edits that will directly affect surgical practice by limiting billing for injections, infusions and catheterizations with many hundreds of codes, as well as various edits affecting common surgical procedures. Revised Excision Codes Include Repairs CCI has followed revisions to the codes for excision of benign lesions in CPT 2003 with a host of new edits. Specifically, 11400 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 0.5 cm or less) now includes intermediate and complex repairs as described by 12031-12057 and 13100-13153, respectively. Excision codes 11420 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less) and 11440 (Excision, other benign lesion including margins [unless listed elsewhere], face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less) are subject to the same restrictions. For Medicare payers and others who follow CCI, lesion excision of less than 0.5 cm includes all repairs, regardless of severity (note that the edits do not apply to excisions of more than 0.5 cm, e.g., those described by 11401-11406). Payers following CPT guidelines bundle only simple repair to lesion excisions. Separate Billing for New Infusion Code Limited The most numerous edits in version 9.0 involve the bundling of 64416 (Injection, anesthetic agent; brachial plexus, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration) to hundreds of surgical interventions, including many vascular (35001-36510 and others) and digestive system (40000 series) procedures.

CPT added 64416 for 2003 to distinguish continuous infusion from single injection as described by 64415* (... brachial plexus, single). As noted in the code descriptor, 64416 includes daily management of anesthetic agent as indicated by 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration), which you, therefore, may not report separately. These edits which are too numerous to list and include procedures as varied as aneurysm or dissection repair (34831), thromboendarterectomy (35301-35381), endoscopies (43259, 43260-43272) and colostomy revision (44340), among others will prevent physicians from billing separately for continuous infusion nerve blocks with surgical procedures. Due to the sheer number of edits and because related codes 64415 and 64417* ( axillary nerve) have also been bundled extensively (although much less frequently than 64416) you should assume that CCI has bundled 64416 to most surgical procedures and report nerve blocks separately for Medicare payers only after consulting version 9.0 to be sure it is not included. New Codes Mean New Edits New-for-2003 artery exposure codes 34833 (Open iliac artery exposure with creation of conduit for delivery of infrarenal aortic [...]