General Surgery Coding Alert

Use this overview to see what’s in store for your surgeons’ coding next year.

You have a lot to get ready for if you’ll be coding for a general surgery practice next year. That’s because the 2017 CPT^® 10000-40000 level surgery codes include more than 40 new, 20 deleted, and nearly 340 revised codes for next year.

Sources: The AMA has released the almost-final, preproduction version of CPT^® 2017. But be aware that you may still see changes to the codes until the AMA officially releases the final version later this fall. Also, you can read about some of the new codes in the 2017 Medicare Physician Fee Schedule (MPFS) proposed rule available at www.federalregister.gov/articles/2016/07/15/2016-16097/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other-revisions.

Look for Overhaul of Moderate Sedation Coding and Pricing

CPT^® 2017 deletes moderate sedation codes 99143-+99150 (Moderate sedation services …) and replaces them with six new codes. The new codes reduce the intraservice time from 30 to 15 minutes — that’s the continuous face to face time beginning with the drug administration until the physician can leave the patient with the independent trained observer.

The new codes are in two families that distinguish between moderate sedation services provided by the “same” versus “other” health care professional than the person performing the diagnostic or therapeutic service. Within each family, CPT^® provides distinct codes for patients age 5 years and older, or younger than 5 years, plus an add-on code for each additional 15 minutes.

CMS has proposed valuing the work for the younger patients at 0.25 Relative Value Units (RVUs) more than patients who are 5 years or older. 

For instance: Here are three of the codes listed in the proposed MPFS:

• 991x3 — Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient younger than 5 years of age
• 991x4 — … initial 15 minutes of intraservice time, patient age 5 years or older
• 991x6 — … each additional 15 minutes intraservice time (List separately in addition to code for primary service)

“For code 991X4, CMS is proposing a work RVU of 1.65 to maintain the 0.25 increment relative to CPT^® code 991X3 (a RUC-recommended work RVU of 1.90) and maintain relativity among the CPT^® codes in this family, says Michael A. Granovsky, MD, CPC, FACEP, President of LogixHealth, a coding and billing company in Bedford, Mass.

Remember: This information is from the proposed rule, and the final CPT^® codes and MPFS 2017 final-rule pricing are expected in November.

Look for surgical code repricing: Along with the overhaul of the moderate sedation codes, CPT^® 2017 makes a singular change to more than 300 codes that general surgeons might report — remove the moderate sedation “bull’s eye” symbol from the code.

“The bull’s eye means that the procedure includes the moderate sedation service, so you can’t separately report the diagnostic or therapeutic procedure code with a moderate sedation code,” explains Marcella Bucknam, CPC, CPC-I, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, internal audit manager with PeaceHealth in Vancouver, Wash. “For a code that no longer has the bull’s eye symbol, you’ll be able to separately report one of the new moderate sedation codes if your surgeon sedates a patient for a procedure that she is performing, or for a procedure that someone else is performing,” she says.

No pay bonus: At the same time as these codes lose the bull’s eye, CMS is proposing to lower the payment to account for the change in how you use the codes. According to the MPFS proposed rule, “we are proposing to maintain current values for the procedure codes less the work RVUs associated with the most frequently reported corresponding moderate sedation code, so that practitioners furnishing the moderate sedation services previously considered to be inherent in the procedure will have no change in overall work RVUs.”

Preview More Surgery Code Changes

General surgeons can expect some code additions, deletions and revisions from the musculoskeletal section to the digestive system section in CPT^® 2017. The following table gives you a snapshot of the changes coming your way:

Look ahead: Keep reading General Surgery Coding Alert in the following months to get the details on how to report your surgeons’ work in the face of these CPT^® changes. Remember that these codes may still change until the AMA officially releases the final version later this fall.