General Surgery Coding Alert

Correct Coding Initiative version 8.0 (CCI 8.0) includes more than 8,000 new edits valid Jan. 1-March 31, 2002. The most important changes for general surgeons involve fine needle aspiration (FNA); endoscopies of the colon, rectum and anus; and laparoscopic enterectomy performed in conjunction with an open partial colectomy.
 
Many of the new surgical edits should not have a significant impact on how practices bill for their services, because the procedures involved should not have been billed separately all along. A sigmoidoscopy, for example, has long been considered bundled if performed during the same session as a colonoscopy, says Kathleen Mueller, RN, CPC, CCS-P, a general surgery coding and reimbursement specialist in Lenzburg, Ill.
 
"Surgeons should remember that not all edits are in the CCI," she says. "There are many principles, conventions and policies that govern procedural coding, all of which can determine whether procedures may be billed separately when performed together."  
 
However, Mueller says, "Physicians who are unfamiliar with the guidelines continue to bill separately for such procedures." As a result, formal edits may be introduced in the CCI to stop the practice.
 
The introduction of CPT codes generates CCI edits that follow existing coding conventions, Mueller says. The introduction of 45136 (excision of ileoanal reservoir with ileostomy) in CPT 2002, for example, generated a comprehensive/component edit involving 45136 and 44005 (enterolysis [freeing of intestinal adhesion][separate procedure]) that accounts for the fact that 44005 is a separate procedure, i.e., a procedure that can only be reported when it is performed on its own and may not be billed when performed in conjunction with a primary procedure.
 
Note: Even if there is no CCI edit, lysis of adhesions (whether open or laparoscopic) performed during another procedure should not be reported separately.
Fine Needle Aspiration
CPT 2002 introduced 10021 (fine needle aspiration; without imagining guidance) and 10022 ( with imaging guidance) for reporting FNA biopsies, noting that codes previously used to report this procedure (88170 and 88171) have been deleted. CCI 8.0 bundles 10021 and 10022 with 19290 (preoperative placement of needle localization wire, breast), as well as with codes for breast excisions (19110-19125, 19140-19200 and 19240), deep or superficial muscle biopsies (20200-20206), pneumocentesis (32400-32420), salivary gland biopsies (42400) and thyroid excisions (60001).
 
Even more codes would likely bundle with 10021 and 10022 were it not for what appears to be a computer glitch or other error, says Susan Callaway, CPC, CCS-P, a coding and reimbursement specialist and educator in North Augusta, S.C.
 
Although CPT 2002 says 88170 (fine needle aspiration; superficial tissue [e.g., thyroid, breast, prostate]) and 88171 ( deep tissue under radiologic guidance) have been deleted, Callaway says CCI 8.0 bundles 88170 and 88171 with breast biopsy codes 19100-19103.
 
She hopes the [...]