General Surgery Coding Alert

Prepare for new open and laparoscopic GES codes, also

CPT 2007 has deleted two codes (44152-44153) for colectomy without proctectomy. As replacements, CPT now includes 44157 (Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, includes loop ileostomy, and rectal mucosectomy, when performed) and 44158 (... with ileoanal anastomosis, creation of ileal reservoir [S or J], includes loop ileostomy, and rectal mucosectomy, when performed) -to more accurately describe performance of total abdominal colectomy with proctectomy and ileoanal anastomosis,- according to the AMA's CPT Changes 2007: An Insider's View.

In the increasingly rare circumstance that a surgeon performs a procedure as described by either of the deleted codes 44152 (Colectomy, total, abdominal, without proctectomy; with rectal mucosectomy, ileoanal anastomosis, with or without loop ileostomy) or 44153 (... with rectal mucosectomy, ileoanal anastomosis, creation of ileal reservoir [S or J], with or without loop ileostomy), CPT has added parenthetical text directing coders to report 44799 (Unlisted procedure, intestine), instead.

CPT 2007 also changes the descriptor for colectomy with proctectomy code 44211 to clarify that it includes a rectal mucosectomy, when performed.

 -A rectal mucosectomy is time-consuming, and not everybody does it,- says surgeon M. Trayser Dunaway, MD, a general surgeon, physician and coder educator, and CEO of Health Care Value in Camden, S.C.

This last revision is purely editorial, however, in that it is merely -a correction of information included in the CPT 2006 codebook,- according to CPT Changes 2007.

Look for GES, Capsule Endoscopy Additions

A cutting-edge treatment, gastric electro stimulation (GES), has two new codes for laparoscopic (43647-43648) implantation/replacement or revision/removal. Another duo covers the same procedures using an open approach (43881-43882).

Until now, you-ve had to use 64999 (Unlisted procedure, nervous system) along with upper GI endoscopy code 43235, neurostimulator insertion code 64590 and electronic analysis code 95970. Having four specific GES codes will make this service much easier to bill for, coding sources say.

One more: Intraluminal gastrointestinal tract imaging (for example, capsule endoscopy) of the esophagus gained a new code with 91111 (Gastrointestinal tract imaging, intraluminal [e.g., capsule endoscopy], esophagus with physician interpretation and report).

-Code 91111 has been established to report capsule endoscopy limited to the esophagus- only, explains CPT Changes 2007. In contrast, 91110 (Gastrointestinal tract imaging, intraluminal [e.g., capsule endoscopy], esophagus through ileum, with physician interpretation and report) is more inclusive and describes imaging the intraluminal esophagus through the ilium.

Because 91110 automatically includes 91111, CPT has added text directing coders not to report 91111 in addition to 91110.