General Surgery Coding Alert

Now you can also describe less-than-total colonoscopy

If you've been struggling to bill for laparoscopic "stomach stapling" and other procedures using an unlisted-procedure code, in 2005 you can access two new codes to describe laparoscopic gastric bypass surgery using Roux-en-Y gastroenterostomy and small intestine reconstruction:

43644 - Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less)

43645 - ... with gastric bypass and small intestine reconstruction to limit absorption. "Although minimally invasive gastric bypass has been popular for some time now, we have needed to submit the unlisted code," says Suzan Hvizdash, BSJ, CPC, physician education specialist for the department of surgery at UPMC Presbyterian-Shadyside in Pittsburgh. The dedicated codes should make for simpler, timelier and more reliable claims' reimbursement, she says.

And CPT 2005 includes a new open bariatric surgery code, 43845 (Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy [50 to 100 cm common channel] to limit absorption [biliopancreatic diversion with duodenal switch]), that solves the longstanding issue of how to code for these more complex procedures and what all is included in them.

Count the centimeters: You can expect a revision to existing restriction and bypass code 43846 (Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb [150 cm or less] Roux-en-Y gastroenterostomy). The new text changes the definition of a "short limb" to 150 cm or less (previous additions of CPT specified 100 cm or less).

Look for "Roux-en-Y" in the documentation: Code  43846 differs from 43845 "because 43846 involves bypass with a Roux-en-Y. The other code [43845] is a different change to the small bowel," says M. Trayser Dunaway, MD, FACS, a general surgeon in Camden, S.C.

No code for laparoscopic banding: CPT does not contain a new code to describe laparoscopic vertical banding, so you'll have to continue to report this procedure using 43659 (Unlisted laparoscopy procedure, stomach). Describe 'Partial' Colonoscopy Using 45391/45392 Separately, CPT 2005 boasts two new codes for flexible colonoscopy proximal to the splenic flexure, which include endoscopic ultrasound examination and transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy respectively:

45391 - Colonoscopy, flexible, proximal to splenic flexure; with endoscopic ultrasound examination

45392 - ... with transendoscopic ultrasound- guided intramural or transmural fine needle aspiration/biopsy(s). These codes will cover procedures that are more than a flexible sigmoidoscopy but less than a full colonoscopy, Dunaway says.

Often, a surgeon will perform a flexible sigmoid-oscopy using a somewhat longer scope, which allows him to get further into the colon. But he will be unable to get past the splenic flexure. Codes 45391 and 45392 will give the physician credit for getting further than a standard flexible sigmoidoscopy, but not quite a full colonoscopy, Dunaway adds. You [...]