General Surgery Coding Alert

Explore online symposium and errata resources.

General surgeons face code changes from every direction this year -- integumentary, vascular, gastrointestinal, E/M, and more. Let us introduce you to some resources that can help you stay abreast of the modifications.

Check Out Symposium Slides

If you want a more in-depth look at what presenters had to say about CPT^® 2013 code changes at the AMA CPT^® and RBRVS 2013 Annual Symposium, you can get a glimpse of the presentation slides online at www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/cpt-rbrvs-symposium.page. You’ll find presentations on the following topics and more:

Broaden healthcare provider terminology: The most widespread changes throughout CPT^® 2013 -- the switch to more inclusive or provider-neutral language -- shouldn’t be difficult for physicians or other providers to put into place.

"The concepts are pretty straightforward," said Richard Duszak, Jr., MD, an AMA CPT^® Editorial Panel member in his symposium presentation, "Qualified Health Care Professional (QHP) Terminology Changes 2013.""There’s been an evolution in CPT^® for how codes report services by non-physicians," he said.

That’s why hundreds of codes were revised for 2013 to replace designations of "physician" with "individual" or "qualified health care professional."

Clarify EGD coding: Make sure you update how you report esophagogastroduodenoscopy (EGD) when your surgeon performs an endoscopy of the upper gastrointestinal (GI) tract.

You can read about the change in the symposium slides from the "Gastroenterology" presentation by Joel V. Brill, MD, AMA CPT Advisory Committee Member. CPT^® 2013 deletes 43234 (Upper gastrointestinal endoscopy, simple primary examination [e.g., with small diameter flexible endoscope] [separate procedure]) and includes a new text note to direct you to instead use 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]).

Deleted code 43234 described a small-diameter endoscope procedure that is now rarely used, so deleting the code clarifies that 43235 most accurately identifies upper GI endoscopy.

Capture care coordination: CPT^® 2013 introduces the following two new codes for transitional care management (TCM) services:

99495 --Transitional care management services with the following required elements: communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge; medical decision making of at least moderate complexity during the service period; face-to-face visit, within 14 calendar days of discharge

99496 -- ... medical decision making of high complexity during the service period; face-to-face visit, within 7 calendar days of discharge.

The codes are meant to represent situations when a physician oversees an "established patient whose medical/psychosocial issues require moderate to high complexity medical decision making (MDM)" during the shift from a healthcare facility setting back to the patient’s community (home) setting, according to David Ellington, MD, a member of the CPT^® Editorial Panel, in his symposium presentation, "E&M -- Care Coordination and Other CPT^® Changes."

Continue enjoying ERX incentives: The combination of electronic prescribing incentive payments and adjustments will remain in place through 2014. Eligible providers who successfully participate in the program will receive 0.5 percent incentive pay in 2013.

"It’s not much, "said Kathy Bryant, deputy director of the department of physician services at CMS in her presentation, "Medicare Physician Fee Schedule Payment," "but it’s better than the 1.5 percent reduction adjustment for not successfully participating."

Find Errata Online

The AMA has made corrections for CPT^® 2013 in the online "Errata," which clarifies minor changes to surgery codes such as 42894 (Resection of pharyngeal wall requiring closure with myocutaneous or fasciocutaneous flap or free muscle, skin, or fascial flap with microvascular anastomosis).

The AMA updates the corrections throughout the year, so it’s smart to check it regularly. You can access it from www.ama-assn.org/go/cpt-errata, according to Peter Hollmann, MD, chair of the CPT^® Editorial Panel in his symposium presentation, "Moving CPT ^® Into the Future." Corrections are made based on review and comments from staff, panel, specialty societies, and anyone else interested in CPT^®, said Hollmann.