Part B Insider (Multispecialty) Coding Alert

The American Medical Association introduced many new codes in the 2003 edition of the CPT. And now that you've had six months to get used to the new codes, you'll have a whole new set of rules to attach them.

For example, the 2003 CPT included new laparoscopy codes 44206 through 44239. And those codes just became a lot more complicated to bill, thanks to the National Correct Coding Initiative version 9.2.

Many of those new codes are now considered components of other codes, while new components have been added to old codes. Each one of those new laparoscopy codes has its own set of edits, sure to bedevil coders for months to come.

For example, you should now consider 44200 (Laparoscopy, surgical; enterolysis) and 44205 (... colectomy, partial, with removal of terminal ileum with ileocolostomy) nonmutually exclusive components of new codes 44206-44212. But 44204 (... colectomy, partial, with anastomosis) will only become a component of 44210-44212.

Meanwhile, new codes 44206-44212 will become components of colectomy codes 44140-44160. And, 44206 (... colectomy, partial, with end colostomy and closure of distal segment) and 44208 (... colectomy, partial, with anastomosis, with coloproctostomy, with colostomy) will become components of new colectomy codes 44210-44212.

The new NCCI revision also introduced some mutually exclusive edits for those codes. For example, 44206 is now mutually exclusive with 44204. And 44207 and 44208 are both mutually exclusive with 44206. Also, 44211 and 44212 are both mutually exclusive with 44210, and 44212 is also mutually exclusive with 44211.

Endoscopy Codes Affected

CPT 2003 also introduced a number of edits for two other new codes for endovascular repair of abdominal aortic aneurysm, 34833 and 34834. These are similar to existing codes 34820 and 34812 respectively, according to a February article in the Bulletin of the American College of Surgeons.

New code 34833 (Open iliac artery exposure with creation of conduit for delivery of infrarenal aortic or iliac endovascular prosthesis, by abdominal or retroperitoneal incision) is now a nonmutually exclusive component of several other codes, including:

 

 endovascular repair of an abdominal aortic aneurysm (34830, 34831, 34832)
 

 repair and graft insertion for an aneurysm (35081-35132)
 

 thromboendarterectomy (35331-35361)
 

 transluminal angioplasty (35452, 35454, 35472, 35473 and 35474)
 

 transluminal atherectomy (35481, 35482, 35490, 35491, 35493 and 35495)
 

 bypass graft, vein (35526-35551, 35560-35565, 35582, 35626-35647, 35651, 35663, 35665, 35671)
 

 exploration/revision (35875, 35876)
 

 transcatheter procedures (37205, 37207).

Some of the edits for 34833 can be overridden by a modifier; others can't. Another new code, 34834 (Open brachial artery exposure to assist in the deployment of an infrarenal aortic or iliac endovascular prosthesis by arm incision, unilateral), also has a similar raft of edits, with some additions.

For example, you can't bill 34834 with some additional codes for repair and graft insertion of an aneurysm, including 35011, 35013, 35045. You also can't bill 34834 with 35321 (Thromboendarterectomy; axillary-brachial).

A new code for shoulder arthroscopy with rotator cuff repair (29827) will now be bundled with arthroscopy codes 29806, 29820, 29822 and 29825.

Endovascular Graft Replacement Targeted

New code 34900 (Endovascular graft replacement for repair of iliac artery) will become more complex to bill as well. This code is now considered a component of endovascular repair of abdominal aortic aneurysm codes 34831 and 34832.

Direct aneurysm repair codes 35102 and 35131 are considered components of 34900. Also, 75630 (Aortography, abdominal plus bilateral iliofemoral lower extremity) and 75952 (Endovascular repair of infrarenal abdominal aortic aneurysm or dissection, radiological supervision and interpretation) become components of 34900. 

Code 35206 (Repair blood vessel; upper extremity) is also considered to be a component of 34900. It's also a component of new codes 34834 and 75954 (Endovascular repair of iliac artery aneurysm, pseudoaneurysm, arteriovenous
malformation, or trauma).

Five codes are now mutually exclusive with 34900: 34800 and 34802, for endovascular repair of infrarenal abdominal aortic aneurysm or dissection; aneurysm repair or graft insertion codes 35103 and 35132; and 37205 (Transcatheter placement of an intravascular stent[s], percutaneous; initial vessel).