Part B Insider (Multispecialty) Coding Alert

Choosing an abdominal lesion excision code will get easier

Cutting-edge surgeries and common procedures that your physician may already be performing will finally have new codes in 2008. They include:

- Osteotomy of spine (22206-22208). A parenthetical note mentions you-ll use these new codes for -pedicle/ vertebral body subtraction.- Surgeons also refer to this procedure as -trans-pedicular three-column osteotomy.- Until now, you-ve had no code to cover this procedure, which involves a posterior approach and includes three columns.

All three of these codes cover posterior or posterolateral approach of three columns and one vertebral segment. Code 22206 applies to the thoracic region, 22207 applies to the lumbar region, and 22208 is an add-on code for each additional vertebral segment.

- Computer-assisted surgical navigational procedure for musculoskeletal procedures (20985-20987). These codes break down into -image-less- computer assistance (20985), assistance with image guidance based on intraoperatively obtained images (20986) and assistance with image guidance based on preoperative images (20987). These are add-on codes, so you should list them in addition to the primary procedure.

- Lung/pleura surgery gets five new codes--but they-re not really new. CPT 2008 deletes 32000-32005 and 32019-32020, and replaces them with new codes that have almost exactly the same descriptors.

The only difference between new thoracentesis codes 32421-32422 and 32000-32005 is that the descriptor of 32422 says -includes water seal ... when performed- instead of -with or without water seal.- Similarly, 32551 is the same as 32020, except for the changed -water seal- language. New code 32560 is exactly the same as 32005, and 32550 is the same as 32019.

- Open excision or destruction of one or more intra-abdominal tumors, cysts or endometriomas (49203-49205). These codes replace 49200-49201, which included retroperitoneal as well as intra-abdominal objects.

Old way: Codes 49200-49201 merely divided into regular and -extensive- excision or destruction.

New way: Codes 49203-49205 provide you with an easier way to figure out which code to use. If the largest tumor is 5 cm or less in diameter, then you code 49203. If the largest tumor is between 5.1 cm and 10 cm in diameter, code 49204. If the largest of the tumors was bigger than 10.0 cm in diameter, code 49205.

- Electronic analysis of implanted gastric neurostimulator pulse generator (95980-95982). These codes include intraoperative analysis (95980), subsequent analysis without reprogramming (95981) and subsequent analysis with reprogramming (95982). There's also a new code for a non-invasive physiologic study of an implanted wireless pressure sensor in an aneurismal sac following endovascular repair (93982).