General Surgery Coding Alert

CPT 2000, which was released last month, has eliminated the laparoscopy/hysteroscopy section (56300-series). The codes that were in this section have been renumbered and dispersed throughout the book, depending on the body area affected by the coded procedure.

This will make it more difficult to find procedures in the book, warns Kathleen Mueller, RN, CPC, CCS-P, a coding and reimbursement specialist in the office of Allan L. Lieffer, MD, in Chester, IL. Before, coders could go to one section and find all the laparoscopic codes; now they will have to locate each one individually, depending on the area of the body that was scoped.

Three new laparoscopic codes also were added: 54692 (orchiopexy for intra-abdominal testis), 58672 (laparoscopy with fimbrioplasty) and 58673 (laparoscopy with salpingostomy). Two of the moved codes were revised. The terminology in 43653, formerly 56346, now needs: gastrostomy, without construction of gastric tube (e.g., Stamm procedure) (separate procedure). Previously, the procedure was defined as gastrostomy, temporary (tube or rubber or plastic)(separate procedure). In addition, 56300 (laparoscopy [peritoneoscopy], diagnostic; [separate procedure]), now listed as 49320, was expanded to indicate laparoscopy in the abdomen, peritoneum and omentum and includes collection of specimens by brushing or washing. (See box on page 34 for list of 56300-series codes that have been relisted elsewhere.)

Critical Care Guidelines Revised

In CPT 1999, codes 99291 and 99292 are used for the critical care, evaluation and management of the unstable critically ill or unstable critically injured patient, requiring the constant attendance of the physician. (99291 is for the first hour, defined as between 30-74 minutes, and 99292 is used for every subsequent 30-minute period.) Surgeons might have interpreted this to mean that caring for a critically ill or injured patient did not meet the codes criteria unless the patient was unstablesuffering from a life-threatening, immediate problem that required stabilization.

CPT 2000 clarifies these codes by removing the unstable requirement. Therefore, if the general surgeon has a patient in the ICU or critical care unit listed as critical and is directly involved with that patient, he or she will be able to use 99291 and 99292 when providing care, evaluation and management for the patient.

Note: If the critical care takes less than 30 minutes, it should be billed as 99233 (subsequent hospital care).

As valuable as this change is, surgeons should note that CPT 2000 states that the critical illness or injury must acutely impair one or more vital organ systems, jeopardizing the patients survival. In other words, services provided for a patient who is not critically ill but nonetheless has been placed in a critical care unit should be reported using evaluation and management codes other than 99291 and 99292.

But there is no doubt the codes have been softened, says Susan Callaway-Stradley, CPC, CCS-P, an independent reimbursement and coding consultant in North Augusta, SC.

Other Changes

In addition to the CPT 2000 changes listed above, 43761 has been reworded to include repositioning of the gastric feeding tube through the duodenum for enteric nutrition by any method. Codes 36533, 36534 and 36535, which involve implantable venous access ports in CPT 1999, have been redefined to substitute device for port.