General Surgery Coding Alert

Check CPT^® editorial panel minutes to glimpse ahead.

You don’t have to wait until the new CPT^®book falls in your lap to prepare for changes that could affect your general surgery practice next year. Preview some of the expected revisions with our experts’ evaluation of AMA code recommendations for 2014.

Caution:The potential revisions below are listed as “accepted” in the CPT^®Editorial Panel meeting summaries. But the actual codes, descriptors, and guidelines won’t be finalized until closer to the time of CPT^® 2014’s official publication.

Toss Out 37204, 37210 for New Embolization Choices

The January-February 2013 CPT^® Editorial Panel Meeting “Summary of Panel Actions” holds a collection of newsworthy changes for your practice (www.ama-assn.org/resources/doc/cpt/summary-jan-feb-2013-panel-meeting.pdf).

One of the accepted changes is to do away with the following embolization codes:

• 37204 — Transcatheter occlusion or embolization (e.g., for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method, non-central nervous system, non-head or neck
• 37210 — Uterine fibroid embolization (UFE, embolization of the uterine arteries to treat uterine fibroids, leiomyomata), percutaneous approach inclusive of vascular access, vessel selection, embolization, and all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the procedure.

In their place, expect four new codes bundling in embolization and occlusion services in the 37XXX range. To help ensure proper reporting, CPT^® plans to add a subsection with new guidelines.

See if Deletion’s in Store for Stent Codes 37205-+37208

The January-February 2013 meeting summary has news for those coders who report stent services, too.

The Editorial Panel accepted the deletion of the following codes:

• 37205-+37206 — Transcatheter placement of an intravascular stent(s) (except coronary, carotid, vertebral, iliac, and lower extremity arteries), percutaneous …
• 37207-+37208 — Transcatheter placement of an intravascular stent(s) (except coronary, carotid, vertebral, iliac and lower extremity arteries), open …
• 75960 — Transcatheter introduction of intravascular stent(s) (except coronary, carotid, vertebral, iliac, and lower extremity artery), percutaneous and/or open, radiological supervision and interpretation, each vessel.

Four new codes in the 37XXX range will replace the deleted codes and will include placement of intravascular stent(s) as well as radiological supervision and interpretation (S&I).

Bundling S&I with the intravascular stent codes seems to be in keeping with the recent AMA trend of creating such combination codes for cardiology, notes Marchelle Cagle, CPC, CPC-I, CMOM, of Alabama-based Cagle Medical Consulting. Such codes can be more straightforward to use and understand, but they often result in decreased reimbursement, Cagle notes. So you’ll want to compare 2013 and 2014 fees, when available, to assess any impact.

Mark Possible Retrograde Cervical Option

You also can anticipate seeing a new 37XXX code for transcatheter stent placement via an open cervical carotid artery access. The code will be specific to retrograde treatment of a lesion. Remember that retrograde means against the direction of blood flow. The January-February 2013 summary shows this request has been accepted.

TCM Guidelines Will Match CMS

CPT^® 2014 promises to work some of the kinks out of new-in-2013 transitional care management (TCM) codes 99495 and 99496.

The Editorial Panel accepted guideline revisions that will indicate TCM services can apply to new patients. The 2013 guidelines limit the codes to established patients, but payers such as Medicare already allow the use of the codes for new patients, too. You’ll also get clarifications about reporting discharge services and other E/M services in addition to TCM.

4 Old FEVAR Codes May Expand to 8 New Options

Finally, the Panel accepted a transition to Cat. I for certain abdominal aortic aneurysm (AAA) Cat.III codes.

According to the January-February meeting summary, codes 0078T-+0081T will be deleted. These codes describe endovascular repair (and related S&I) of AAA, pseuodoaneurysm, or dissection of the abdominal aorta involving visceral branches and using a prosthesis.

The move to Cat. I will result in eight new 348XX codes. The codes will include endovascular repair and S&I. You’ll also have new guidelines and instructions to help you properly code these services, which are known as fenestrated endovascular repair (FEVAR).

The move from Cat.III to Cat. I is a positive one, notes Cagle. The move suggests the Cat. III AAA/FEVAR codes were used enough to show the services deserved Cat. I codes. Cat. I codes “are more easily processed and recognized by the insurance payers for payment,” she says. Plus, Cat. I codes typically have higher reimbursement than Cat. III codes, Cagle says. Codes 0078T-+0081T are carrier priced for Medicare.

Make the Most of Online CPT^® 2014 News

You may access all available Panel Action Summaries from www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/cpt-summary-panel-actions.page.

The files related to the items above are “2013 Jan-Feb, CPT^® Editorial Summary of Panel Actions” and “2012-Oct, CPT^® Editorial Summary of Panel Actions.”

There may be more changes to come. Actions from the May meeting will be posted this summer, and you can preview the agenda at www.ama-assn.org/resources/doc/cpt/may-2013-public-panel-agenda.pdf.