General Surgery Coding Alert

Although many new code combinations have been added with version 8.1 of the Correct Coding Initiative (CCI) that involve general surgery procedures, virtually all reinforce already-existing coding protocols (such as bundling CPT-designated "separate procedures" with more extensive related codes) and should not affect billing or revenue significantly. Most of the edits are proactive rather than reactive, says Jan Rasmussen, CPC, a general surgery coding and reimbursement specialist in Eau Claire, Wis. "For the first few years, the CCI reacted, trying to correct errors. With most of those edits out of the way, they seem to be turning their attention to proactive edits that are consistent with AMA/CPT guidelines."

The edits should clear up any confusion regarding whether two services are automatically billable if there is no edit in the CCI. "Just because there isn't an edit does not mean you can bill the two services together," Rasmussen says. For example, 38500 (Biopsy or excision of lymph node[s]; open, superficial) now is bundled with lymphadenectomy codes 38700-38747, which is consistent with Medicare guidelines that include such biopsies in more extensive excisions. The edit has a "1" indicator, however, which means it may be bypassed with a modifier when appropriate. If the biopsy was diagnostic and led to the decision to perform the lymphadenectomy, modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) should be appended to the appropriate lymphadenectomy code to indicate the procedure was preplanned (if the biopsy returned positive). Note: In version 7.3 (October-December 2001), Medicare revised the CCI guidelines in Chapter 1 concerning diagnostic endoscopies (and, by extension, diagnostic biopsies). Prior to version 7.3, surgeons were not instructed to use modifier -58; instead, they were required to append modifier -59 (Distinct procedural service) to the diagnostic procedure code. Some carriers still may require modifier -59 in such cases. Other edits that validate existing correct coding practices include: Debridement With Complex Repairs. Debridement codes 11000-11044 now are bundled with complex repairs (13100-13152). Debridements normally are part of wound repair, notes Barbara Cobuzzi, MBA, CPC, CPC-H, a coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J. She notes that the definition of complex repair of the CPT manual states: "Necessary preparation includes creation of a defect for repairs ... or the debridement of complicated lacerations or avulsions " Therefore, Cobuzzi says, "it makes sense that CCI now bundles debridements with these procedures." Fine Needle Aspiration With More Extensive Biopsies. CPT 2002 introduced two new fine needle aspiration (FNA) codes: 10021 (Fine needle aspiration; without imaging guidance) and 10022 ( with imaging guidance). Both codes now are bundled with many more extensive biopsy procedure codes. Esophagoscopy [...]