General Surgery Coding Alert

Early information suggests significant changes to CPT for 2008, including nearly 250 new and 300 revised codes, and over 50 code deletions. The makeover will affect all portions of CPT but include perhaps fewer than 100 relatively minor revisions to the codes most often used in general surgery practice, including E/M service codes.

The biggest news for general surgeons, perhaps, is the revision of 11008, which describes removal of implanted mesh. Many coders were disappointed when CPT released this code in 2005 and limited its use as an add-on with 11004-11006, and only for cases of necrotizing fasciitis.

Mesh removal is often "incredibly time-consuming" and complicated because you have to remove the mesh in pieces, says M. Trayser Dunaway, MD, a surgeon, speaker, coding educator and healthcare consultant in Camden, S.C. The descriptor for 11008 has been "a source of confusion" for coders because "a necrotizing infection is not typical," he adds.

In CPT 2008, the AMA will reportedly change the code descriptor of 11008 to specify "Removal of - mesh - for infection (e.g., for chronic or recurrent mesh infection or necrotizing soft tissue excision)." This opens up the possibility of using the code for removal of infected mesh following hernia repair, for instance, instead of only in cases of extreme infection. At this time, however, we cannot confirm that CPT will increase the range of codes with which you may apply this add-on code.

Similarly, early information suggests that the descriptor for 49568 will gain new language allowing that it is the proper code to report placement of mesh for closure of debridement for necrotizing soft tissue infection, as well as for placement of mesh during incisional or ventral hernia repair.

CPT 2008 also brings the potential for at least one new feeding tube placement code, 49440, which will describe percutaneous insertion of a gastrostomy tube under fluoroscopic guidance, along with new codes for transcatheter placement and central venous access.

Finally, on the E/M front, sources reveal that there will be three new, time-based codes for telephone services in place of previous codes 99371-99373, as well as at least one new Category I code (9944x) for online E/M visits -- so-called "e-visits" -- to replace Category III code 0074T.

Additionally, CPT will add reference times to several E/M code categories that did not previously include them, such as nursing facility care (99304-99310) and annual nursing facility assessments (99318).

Most disappointingly, however, the AMA seems to have added no guidance to CPT to clear up the confusion over what constitutes a consultation rather than a "transfer of care" (see the reader question "Expect Consult Confusion to Continue," elsewhere in this issue).

Don't get too excited yet: "Just because you have new codes, that doesn't mean Medicare will pay," says Marti Geron, CPC, CMA, CM, reimbursement manager with University of Texas Southwestern Medical Center in Dallas. In fact, CMS traditionally does not pay for non-face-to-face services, of which telephone and Internet visits are examples.

The AMA officially releases the new CPT codes at its annual Chicago conference in November. Keep watching General Surgery Coding Alert for a complete appraisal of all the new codes that will affect your practice most.