General Surgery Coding Alert

CCI 18.2 changes 'override' option for many surgical codes.

New Correct Coding Initiative (CCI) edit pairs that affect your surgical practice aren't the only thing you need to know about in the latest update from CMS.

CCI 18.2 also changes the modifier indicator for 532 existing code pairs. "Unfortunately, 531 went from an indicator of '1' (you can use a modifier) to a '0' (you can't use a modifier)," states Frank D. Cohen, MPA, MBB, senior analyst with Frank Cohen Group, LLC in his analysis of the changes. And unfortunately for your practice, nearly 250 of those changes to "0" involve general surgery procedures.

Never Unbundle Enterolysis

Freeing intestinal adhesions might be a time-consuming step that your surgeon describes in the op note for some laparoscopic procedures, but don't expect to assign a distinct code for the work.

CCI already bundled 44180 (Laparoscopy, surgical, enterolysis [freeing of intestinal adhesion] [separate procedure]) with hordes of laparoscopic procedures, but CCI 18.2 kicks it up a notch. The latest CCI update changes the modifier indicator for nearly 230 of those edit pairs from "1" to "0."

Follow guidelines: Because CPT® identifies 44180 as a "separate procedure," you're already limited to using the code when it's the only procedure performed at an operative session at a given anatomic site.

But with a "1" modifier indicator, you could override the edit pair when the enterolysis took place at an operative session or anatomic site distinct from the bundled procedure. With a "0" modifier indicator, that option is gone.

Turn to 22: If your surgeon documents extensive additional work for the adhesiolysis, you might be able to capture the extra work using modifier 22 (Increased procedural services).

You can only make the case for using modifier 22 when the surgeon documents that the adhesions represent a significant amount of additional work and add considerable time to the procedure, not when the lysis is done simply to access the surgical site, explains Melanie Witt, RN, COBGC, MA, an independent coding consultant in Guadalupita, N.M.

Another 'Separate Procedure' Goes '0'

Similar to enterolysis, CCI 18.2 changes the modifier indicator from "1" to '0' for procedures bundled with 43653 (Laparoscopy, surgical; gastrostomy, without construction of gastric tube [e.g., Stamm procedure] [separate procedure]).

For instance: If your surgeon forms a gastric tube as part of a sleeve gastrectomy (43775, Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy [i.e., sleeve gastrectomy]), you can't override the edit pair under any circumstances.

Add to New Hiatal Hernia Restrictions

Along with the new hiatal hernia edit pairs discussed in "Rethink Your Hiatal/Diaphragmatic Hernia Coding Boundaries," CCI 18.2 also changes the modifier indicator for existing hiatal hernia bundles. You'll now face a "0" instead of a "1" for all bundled procedure codes within the range 43332-43337 (Repair, paraesophageal hiatal hernia [including fundoplication] ... except neonatal...).