General Surgery Coding Alert

Reporting your general surgeon's service with an unlisted code means more documentation work and a payment guessing game -- that's why you'll welcome CPT 2010's more specific codes.

Let our experts introduce you to a pair of specific lap codes and host of new tumor incision codes that you'll need to know starting Jan. 1.

When your general surgeon repairs a large abdominal wall defect, you didn't have a way to report the work -- until now.

CPT 2010 adds 14301 (Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm) and +14302 (... each additional 30.0 sq cm, or part thereof [List separately in addition to code for primary procedure]) for these services. "We often see really massive abdominal wall repairs ��" much more than a typical ventral hernia -- that require adjacent tissue transfers to cover the defect," notes Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program. "Prior to the 14301-14302 addition, there was no real way to appropriately describe this work, because existing codes didn't describe repair of very large defects."

Bypass the unlisted codes -- you now have two new codes for laparoscopic paraesophageal hernia repair:

• 43281 -- Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; without implantation of mesh

• 43282 -- ... with implantation of mesh.

The new codes should help clarify remaining confusion about CPT 2009 revised lap hernia repair coding. The code changes will also help coders distinguish these paraesophageal hernias from epigastric hernias, according to Bucknam.

Don't miss: "Note that CPT lists these laparoscopic codes under the esophagus section, but the open code for paraesophageal hernia repair is under the diaphragm section (39502, Repair, paraesophageal hiatus hernia, transabdominal, with or without fundoplasty, vagotomy, and/or pyloroplasty, except neonatal)," Bucknam says.

General surgeons have performed sleeve gastrectomies by lap approach for some time, but CPT didn't provide a specific code until the AMA added 43775 (Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy {i.e., sleeve gastrectomy]) this year.

"There has been quite a bit of confusion about bundling on these procedures as well as medical necessity requirements. Having a specific code will help with that," Bucknam says.

CPT 2010 revises 14 anus excision codes and shuffles them around. The code changes in the range 46200-46280 tighten up hemorrhoidectomy coding and other procedures such as fissurectomy.

Watch for non-numerical entries: You'll see a new CPT convention in this section -- resequencing codes.CPT indicates resequenced codes by marking them with # instead of assigning a new code number. That's why you'll see revised hemorrhoidectomy codes out of numerical order, as follows:

• 46221 -- Hemorrhoidectomy, internal, by rubber band ligation(s)

• # 46945 -- Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group

• # 46946 -- ... 2 or more hemorrhoid columns/groups

• # 46220 -- Excision of single external papilla or tag, anus.

"Resequencing makes a lot of sense to avoid renumbering the codes," explained William T. Thorwarth, Jr., MD, in "CPT 2010 Overview" at the CPT and RBRVS 2010 Annual Symposium's opening session in Chicago.

New code 46707 (Repair of anorectal fistula with plug [e.g., porcine small intestine submucosa (SIS)]) replaces the Category III code 0170T with the same descriptor.

Category III codes are important tracking mechanisms that often describe emerging technology, services, and procedures that aren't yet listed under Category I.

Benefit: Although you should report a Category III code that accurately describes the service when there is no other option under the Category I codes, payment for Category III codes is often doubtful. That's why having a new Category I code for the anorectal fistula plug repair may mean more money for your practice.