General Surgery Coding Alert

Know when to bundle imaging services.

The only thing constant is change — so get ready for new, deleted, and revised CPT® 2019 procedure codes that will impact how you report your general surgeons’ services.

Dig into our expert tips to make sure you’re ready to seize the opportunities and avoid the errors when Jan. 1 rolls around.

Tip 1: Tackle These PICC Additions, Revisions

CPT^® 2019 embraces a new way to report peripherally inserted central venous catheters (PICC) with some code additions and revisions.

Additions: You’ll have the following two new PICC codes for 2019:

• 36572 (Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; younger than 5 years of age)
• 36573 (… age 5 years or older).

These two new codes were created to describe PICC line procedures that bundle imaging guidance, image documentation, and all associated radiological supervision and interpretation, says Cynthia A. Swanson, RN, CPC, CEMC, CHC, CPMA, senior manager of healthcare consulting for Seim Johnson in Omaha, Nebraska.

“PICCs may be placed or replaced with or without imaging guidance,” explains Swanson. “The PICC line CPT^® codes were referred from the Relativity Assessment Workgroup (RAW) to bundle imaging. One goal of the RAW is to identify potentially mis-valued services using objective mechanisms for reevaluation.”

Revisions: The addition of new PICC-line codes means that you’ll also need to embrace the following revised codes to distinguish services that don’t involve imaging guidance (changes underlined for emphasis):

• 36568 (Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; younger than 5 years of age)
• 36569 (… age 5 years or older)
• 36584 (Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through same venous access, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the replacement).

“The introductory language and parentheticals have been updated to ensure that CPT^® codes 36568 and 36569 are used to report PICC placement ‘without imaging guidance,’ and code 36584 is revised to ‘include imaging guidance, image documentation, and radiological supervision and interpretation’ required to perform the replacement of a PICC,” according to Swanson. “The central venous access procedures guidelines in the CPT^® codebook are updated to reflect these changes.”

This change will assist in the accurate coding, reporting, and billing of PICC services in today’s healthcare environment, including updated relative value unit (RVU) assignments and corresponding reimbursement for these new and revised PICC codes, Swanson explains.

Tip 2: Look for More ‘Imaging’ Changes

As CPT^® moves toward creating more comprehensive codes that include all services, including imaging, PICC lines aren’t the only procedures impacted for 2019. In fact, the updated code set overhauls fine needle aspiration (FNA) coding to incorporate imaging guidance details, giving you 10 codes in the range 10004 to 10021 to choose from staring Jan. 1.

The FNA overhaul involves deleting one code, revising one code, and adding nine new codes to describe various imaging-guidance methods, including ultrasound, fluoroscopic, computed tomography (CT), and magnetic resonance (MR) guidance.

With all these changes involving imaging guidance, documentation will be key to using the codes correctly.

You’ll need to ensure that the op reports are complete, and clearly describe the provider’s role, according to Julie-Leah J. Harding, CPC, CPMA, CEMC, CCC, CRC, CPEDC, RMC, PCA, CCP, SCP-ED, CDIS, AHIMA-approved ICD-10 trainer and ambassador and director of revenue operations at Boston Children’s Hospital in Boston, Massachusetts.

Tip 3: Bring On New Skin-Biopsy Choices

Another surgery section that CPT^® 2019 overhauls is skin biopsy, currently described by these two codes:

• 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; single lesion)
• +11101 (… each separate/additional lesion (List separately in addition to code for primary procedure)).

Beginning Jan.1, you’ll need to start using six new codes in the range 11102-+11107 to describe different types of skin biopsies, such as punch, incisional, and tangential (such as shave). You’ll no longer report any skin biopsies with deleted codes 11100-+11101.

Tip 4: Keep Reading

You can see that we’ve barely touched on the changes to FNAs and skin biopsies, and CPT^® 2019 includes even more modifications you’ll need to know for your general surgery practice next year. Look to future issues of General Surgery Coding Alert to get the lowdown on all the updates you need to know.

Bottom line: You need to prepare every year for CPT® updates, “to ensure correct coding and not to miss any new coding opportunities that may become available,” says Carol Hodge, CPC, CDEO, CCC, CEMC, coder at St. Joseph’s in Savannah, Georgia.