General Surgery Coding Alert

Use notes to clarify coding bundles, too.

Hopefully you’re used to the esophageal endoscopy coding paradigm instituted in 2014, because CPT® 2015 is at it again. 

With one new code, four revised codes, and a host of new instructions in the range 43180-43233 (Esophagoscopy …), you have a lot to learn. Let us give you the lowdown on how your esophagoscopy coding will change starting Jan. 1.

Welcome Zenker’s Diverticulum Fix

When your surgeon performs an open surgical procedure to resect a Zenker’s diverticulum, you have 43130-43135 to report the procedure (Diverticulectomy of hypopharynx or esophagus, with or without myotomy …), with the codes distinguishing a cervical or thoracic approach.

But you haven’t had a code to report a common endoscopic alternative Zenker’s diverticulum treatment — until now. 

CPT® 2015 adds 43180 (Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus [e.g., Zenker’s diverticulum], with cricopharyngeal myotomy, includes use of telescope or operating microscope and repair, when performed) to describe the procedure.

“The good news is that physicians finally have gotten a code for doing endoscopic repair of Zenker’s diverticulum,” says Barbara J. Cobuzzi, MBA, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. “Coders will no longer have to use an unlisted code to report this service.”

You may see the procedure referred to by various names, such as endoscopic transoral stapling of Zenker’s diverticula, transoral resection of short segment of Zenker’s diverticulum, endoscopic cricopharyngealmyotomy, or transoral repair of Zenker’s diverticulum.

Terminology: Zenker’s diverticulum is a “pocket” that occurs at the junction of the pharynx and esophagus. The condition often occurs in older patients, trapping food in the back of the throat and causing difficulty swallowing, regurgitation, and possibly aspiration pneumonia. 

Greet Code Revisions, Too

Despite the fact that CPT® 2014 showered the esophagoscopy section with 12 new and 14 revised codes that you’ve been using this year, you won’t find the section unchanged this year. 

What’s the same: CPT® 2015 keeps the basic structure of the section intact, with codes distinguished by rigid or flexible scopes, and by transnasal or transoral approach. Within these larger divisions, CPT® provides individual codes for specific services such as biopsy, injections, foreign body removal, and so on. 

What’s different: CPT® 2015 makes minor revisions to four codes. The following two codes changed slightly to clarify that the service includes removing one or more foreign bodies, not just a single foreign body:

• 43194 — Esophagoscopy, rigid, transoral; with removal of foreign body(s)
  
• 43215 — Esophagoscopy, flexible, transoral; with removal of foreign body(s).
  

CPT® 2015 also removes “bipolar cautery” as part of the descriptor for 43216 (…with removal of tumor[s], polyp[s], or other lesion[s] by hot biopsy forceps). 

The change reflects the fact that most surgeons now avoid bipolar cautery due to increased bleeding risk.  

“If your surgeons still use bipolar cautery, you should no longer report 43216, but should instead turn to another code depending on the procedure, such as 43202 (Esophagoscopy, flexible, transoral; with biopsy, single or multiple) or 43229 (Esophagoscopy, flexible, transoral; with ablation of tumor[s], polyp[s], or other lesion[s] [includes pre- and post-dilation and guide wire passage, when performed]), or possibly an unlisted code,” says Marcella Bucknam, CPC, CPC-I, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, internal audit manager with PeaceHealth in Vancouver, Wash.

Finally, CPT® 2015 tweaks the 43197 definition to standardize language by changing “includes” to “including,” but the change makes no difference in how you should use the code (43197, Esophagoscopy, flexible, transnasal; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]). 

Don’t Ignore Notes

Perhaps the biggest change to the esophagoscopy section is the large number of new and revised text notes following many of the codes. 

Learn code restrictions: CPT® 2015 adds instructions for numerous codes in the range 43180-43233 that state, “Do not report [code number] in conjunction with [other code number(s)].” 

“These notes essentially serve as CPT® bundling instructions,” Bucknam explains. “In other words, the notes tell you which esophagoscopy and other codes you should not report together for various reasons,” she says.

For instance: The instructions may bundle the codes because they’re mutually exclusive, such as 43197 for flexible transnasal diagnostic esophagoscopy and 43200 (Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]). These codes are the same except for the approach — transoral or transnasal — so the surgeon performs one or the other. 

Or the instructions might bundle the codes because one code is a component of another, such as 43191 (Esophagoscopy, rigid, transoral; diagnostic, including collection of specimen[s] by brushing or washing when performed [separate procedure]) and 43192 (…with directed submucosal injection[s], any substance). Code 43192 includes the diagnostic scope described by 43191.

Handy tool: The following table summarizes the text notes added or revised in the esophagoscopy section of CPT® 2015, most of which involve bundling restrictions.