General Surgery Coding Alert

Changes in CPT 2003 will allow surgeons to include margins when measuring lesion size, thereby increasing the total area of all excisions reported. Other revisions to CPT for 2003 include several important new codes to identify services previously reported with "unlisted procedure" or imprecise substitute codes, as well as text clarifications that alter previously established coding principles. Lesion Removal: Measure Those Margins Perhaps the most significant changes to CPT 2003 for general surgery coders are guideline revisions for measuring and reporting lesion removal. Previous CPT editions have allowed surgeons to report removals according to the size of the lesion only, rather than based on the size of the area actually removed.

Specifically, CPT now instructs physicians and coders to choose codes for removal of benign (11400-11446) and malignant (11600-11646) lesions by "measuring the greatest clinical diameter of the apparent lesion plus that margin required for complete excision (lesion diameter plus the most narrow margins required equals the excised diameter)" [emphasis added]. Note that the physician should measure the lesion and margin prior to excision because pathology specimens generally shrink in the laboratory and therefore will not provide appropriate dimensions. The CPT changes probably won't result in increased payments, however. Marcella Bucknam, CPC, CCS-P, CPC-H, CCA, HIM Program Coordinator at Clarkson College in Omaha, Neb., predicts either that CMS will reduce the fee schedule value for the lesion codes or that it will issue instructions to continue to report only lesion size (not including margins) for Medicare carriers. Alternatively, CMS may develop dedicated HCPCS codes for lesion removal for Medicare carriers. Look to future issues of General Surgery Coding Alert for more information as it becomes available. New Lap Codes Replace Unlisted-Procedure Code In another important move, CPT 2003 adds six new codes to describe laparoscopic colectomy. These codes represent the laparoscopic equivalent of several already-established open procedures:

44206 Laparoscopy, surgical; colectomy, partial, with end colostomy and closure of distal segment (Hartmann type procedure) (analogous to open procedure 44143) 44207 colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) (open procedure: 44145) 44208 colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) with colostomy (open procedure: 44146) 44210 colectomy, total, abdominal, without proctectomy, with ileostomy or ileoproctostomy (open procedure: 44150)

44211 colectomy, total, abdominal, with proctectomy, with ileoanal anastomosis, creation of ileal reservoir (S or J), with loop ileostomy, with or without rectal mucosectomy (open procedure: 44152, ... with or without loop ileostomy, or 44153, creation of ileal reservoir [S or J], with or without loop ileostomy)

44212 colectomy, total, abdominal, with proctectomy, with ileostomy (open procedure: 44155). These new codes will reduce dependence on unlisted-procedure codes such as 44209, says M. Trayser Dunaway, MD, FACS, a general [...]