General Surgery Coding Alert

Make sure to use two codes, when appropriate.

If you didn’t notice the small change this year to more than 300 CPT^® codes for procedures that your general surgeons may perform, you could stand to lose a lot of money in 2017.

The change involves removing the “bull’s eye” symbol from the codes, meaning that the codes no longer include conscious (moderate) sedation services.

Payment reduction: Corresponding to those CPT^® code changes that remove moderate sedation services, you’ll see a payment reduction for those procedures on the Medicare Physician Fee Schedule (MPFS). For instance, you’ll see the following MPFS payment reductions in 2017 despite the increase in the conversion factor (CF) from 35.8043 in 2016 to 35.8887 this year:

• 45380 (Colonoscopy, flexible; with biopsy, single or multiple) non facility national payment rate decreases from $476.55 in 2016 to $412.72 in 2017
• 36561 (Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older) non facility national payment rate decreases from $1200.52 in 2016 to $1110.04 in 2017

Separate code is key: As of Jan. 1, you should be using a separate code in addition to the surgical procedure code if you need to document that your surgeon performed the moderate sedation associated with the procedure. If you fail to add the appropriate code, you stand to lose not only the income from the reduced MPFS payment for the surgical code, but the pay for the moderate sedation codes as well. See “Capture Pay for Sedation by Surgeon” on page 11 to learn how to separately code for conscious sedation services.

Caution: If your surgeon doesn’t provide the sedation during the procedure, you essentially got paid for it anyway prior to Jan. 1. Now you can expect to earn less pay for the same service you performed last year.

Notice: CPT^® 2017 deletes all codes from Appendix G, which previously listed all codes that include moderate sedation. Instead, a new note directs coders, “For information/guidance on reporting moderate (conscious) sedation services with codes formerly listed in Appendix G, please refer to the guidelines for codes 99151, 99152, 99153, 99155, 99156, 99157.”

Understand Endoscopy Transformation

Removing conscious sedation from hundreds of codes “will have a big impact on physicians who do scopes frequently,” says Lisa Center, CPC, Physician Practice Manager, Via Christi Hospital Pittsburg, Inc. Pittsburg, KS.

There is a great “concern over removal of moderate sedation from endoscopy procedures because of reduction in reimbursement,” echoes Catherine Brink, BS, CMM, CPC, CMSCS, CPOM, president, Healthcare Resource Management, Inc. Spring Lake, NJ.

How the change came about: “The landscape for ambulatory endoscopy procedures has changed over the past decade,” says Michael Weinstein, MD, former representative of the AMA’s CPT^® Advisory Panel. Physicians have recognized benefits in using Propofol sedation administered by an anesthetist, compared to the benzodiazepine and narcotic combination sedation method administered by the physician-nurse team. “More than half of ambulatory procedures are now performed with Propofol sedation and the change in the coding rules reflects the change in practice.”

Under the old code configuration that included moderate sedation in the primary procedure, the anesthetist could submit a claim for sedation administration services, but the surgeon performing the endoscopy could not submit a separate claim for administering sedation. That changes with the CPT^® 2017 update.

Endoscopy codes that have been revised to remove the conscious sedation symbol include:

• 43200 to 43232 (Esophagoscopy, flexible, transoral; …)
• 43235 to 43259 (Esophagogastroduodenoscopy flexible, transoral;…)
• 43260 to 43278 (Endoscopic retrograde cholangiopancreatography (ERCP);…)
• 44360 to 44379 (Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum;…)
• 44380 to 44384 (Ileoscopy, through stoma;…)
• 44385 to 44386 (Endoscopic evaluation of small intestinal pouch (e.g., Kock pouch, ileal reservoir [S or J]);…)
• 44388 to 44408 (Colonoscopy through stoma;…)
• 45300 to 45327 (Proctosigmoidoscopy, rigid; …)
• 45330 to 45350 (Sigmoidoscopy, flexible; …)
• 45378 to 45398 (Colonoscopy flexible;…).

Plus: Expect removal of conscious sedation from 49405-49407 (Image-guided fluid collection drainage by catheter [e.g., abscess, hematoma, seroma, lymphocele, cyst]…), gastric or intestinal tube placement codes (49440-49446), and many procedure codes relating to the biliary duct in the range 47532-47544.

Look for Vascular Impact, Too

In addition to the many endoscopy codes impacted by the removal of moderate sedation services, your general surgeons should expect a similar change if they perform vascular procedures.

For instance, you’ll see the conscious sedation symbol removed from the following codes in CPT^® 2017:

• 36010 to 36254, Catheter placement services
• 36481 to 36590, Central venous access device services
• 37184 to 37218, Transcatheter procedures for thrombosis treatment, stenting
• 37220 to 37239, Endovascular revascularization
• 37241 to 37244, Vascular embolization and occlusion.

Read on to see how you should capture moderate sedation pay when your surgeon provides sedation in addition to one of the preceding procedures.