General Surgery Coding Alert

CPT also adds new codes for APBI catheter, debridement

Revisions to integumentary system codes 10040-19499 in CPT 2005 mean you'll be able to report several procedures that previously had no codes - including, most notably, a long-awaited code for removal of mesh prosthetic.

Get ready now: Keep in mind that for 2005, neither Medicare payers nor practices billing Medicare payers are allowed the usual 90-day "grace period" to transition to the new codes. Beginning Jan. 1, 2005, you must use CPT 2005 exclusively for Medicare payers, according to CMS transmittal 95 (February 2004). 11008 Describes Mesh Removal, But Wait for CPT Instructions With +11008 (Removal of prosthetic material or mesh, abdominal wall for necrotizing soft tissue infection [list separately in addition to code for primary procedure]), CPT finally includes a code you can use when the surgeon removes prosthetic mesh, but it's too soon to determine if 11008 is your magic bullet for all mesh removal cases.

"The problem lies with how CPT will define 'necrotizing,' " says M. Trayser Dunaway, a general surgeon in Camden, SC. "All infections are necrotizing to a degree, but most clinicians aren't going to label an infection necrotizing unless it is a rampant, overwhelming, 'flesh-eating' infection."

In other words, depending on CPT instructions and/or payer response, you may be able to apply 11008 only in limited circumstances, when the mesh has become severely and dangerously infected.

Surgeons often place mesh to strengthen hernia repairs, but if the mesh becomes infected, the surgeon must remove it, which can prove difficult and time-consuming.

Prior to 2005, CPT included no code to describe this service, leaving coders to guess whether they should turn to an unlisted-procedure code, apply modifier -22 (Unusual procedural services) to the primary surgery code to describe the additional work, or simply included the mesh removal as an unreimbursable component of the surgery.

"We just don't know yet if 11008 will solve the problem or only confuse the situation," Dunaway says.

This much is sure: Because removal of infected mesh always occurs during another, more extensive procedure, the AMA has designated 11008 as an add-on code. Therefore, you should only report 11008 in addition to another, primary procedure code.

APBI Catheter Placement? Now There's 19296-19297 Surgeons placing catheters for accelerated partial breast irradiation (APBI) no longer have to scratch their heads and wonder how they will be paid.

Two new codes cover the procedure: 19296 (Placement of radiotherapy afterloading balloon catheter into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; on date separate from partial mastectomy) and add-on code +19297 (Placement of radiotherapy afterloading balloon catheter into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; concurrent with partial mastectomy [list separately in addition to code [...]