General Surgery Coding Alert
Here's How
CPT usually groups constituent codes with parent In this case, 45303, 45305 and 45307 describe more extensive procedures than the base code, 45300. In other words, 45303, 45305 and 45307 include all the work involved in 45300 plus something extra (such as dilation, biopsy, etc.). Generally, you will find the endoscopic base code listed directly above its more inclusive variants, as in the above example, Jandroep says.
CPT and CMS group endoscopic codes into -families- of similar services. The first code in any family (the base or -parent- code) describes the basic procedure. Following the base code, CPT lists any variants that -go beyond- and include the base procedure, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, CPC-EMS, CEO of Coding and Reimbursement Network Inc. and an AAPC National Advisory Board member from 2003 to the present.
Example: Consider this partial code family:
- 45300--Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)
- 45303---with dilation (e.g., balloon, guide wire, bougie)
- 45305---with biopsy, single or multiple
- 45307---with removal of foreign body.
Remember: Surgical scope always includes diagnostic scope, even if the diagnostic scope is not a part of the same code -family- as the surgical scope. In some cases, for instance, the diagnostic scope code may appear some distance from its -surgical- counterparts in the CPT manual.
Example: Surgical laparoscopy 43644 (Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy [roux limb 150 cm or less]) includes diagnostic laparoscopy 49320 (Laparoscopy, abdomen, peritoneum and omentum, diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]), which appears in a different section of CPT.
Tip: When the diagnostic and surgical endoscopy codes are not listed together as part of a code -family,- CPT provides instructions on where to find the diagnostic procedure. For example, a note preceding 43644 in CPT instructs, -To report a diagnostic laparoscopy (peritoneoscopy) (separate procedure), use 49320.-
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