Part B Insider (Multispecialty) Coding Alert

Colonoscopy, laparoscopy become part of stomach procedures

If your physician is performing a lot of digestive system surgeries, you'll have to be more careful about billing endo-scopies and colonoscopies with those procedures after July 1.

Thanks to CCI Version 10.2 , CPTcode 43201 (Esophagoscopy, rigid or flexible; diagnostic, with directed submucosal injec-tion(s), any substance) will become a component of dozens of codes in the digestive surgery area, particularly repair (43300-43352), excision (43610-43641) and other procedures (43800-43865). Almost every code in these areas will be a comprehensive code with 43201 after July 1, but you'll be able to bill with a modifier.

Code 43236 (Upper gastrointestinal endoscopy including esophagus and either the duodenum and/or jejunum as appropriate; diagnostic, with directed submucosal injection(s), any substance) becomes a component of many of the same excision and "other procedures" codes such as 43201.

Many codes became bundled with both 43201 and 43236, including intravenous surgery codes 36005-36015, small intestinal endoscopy codes 44360 and 44376, injection codes 90782-90784 and pulse oximetry codes 94760-94761. Also, 36013-36015 became components of heart catheterization codes 95324 and 95330-95333.

Both 43201 and 43236 become components of 96570 (Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s)).

Laparascopy code 44200 will be deemed a component of several other laparascopy codes for the digestive, urinary system, female genital and male genital systems (43651-43652, 44201, 47560-47561, 47570, 50542-50543, 55550, 55866, 57425, 58545-58546, 58553, 58671-58673). CPTcode 44200 also became a component of 49419 (Insertion of intraperitoneal cannual or catheter, with subcutaneous reservoir, permanent), omental flap codes 49904-49905, and 50690 (Injection procedure for visualization of ileal conduit and/or uretopyelogra-phy, exclusive of radiologic service).

Some codes become components of 45386 (Colonoscopy, flexible, proximal to splenic flexure, with dilation by balloon, 1 or more strictures) and 45340 (Sigmoidoscopy, flexible; diagnostic, with dilation by balloon, 1 or more strictures).

Sigmoidoscopy codes 45341-45345, 45378, and 45382 all become components of 45386, while manipulation codes 45900 and 45915 become components of both 45340 and 45386. Also components of both 45340 and 45386 after July 1 are fissurectomy code 46220, anoscopy code 46600 and anal fissure curettage or cautery codes 46940-46942.

Endoscopy codes 45300-45339 will all become components of 45386. Among those, 45300-45330 and 45334 will also turn into components of 45340. Meanwhile, 45340 turns into a component of colonoscopy codes 45378-45380, 45382-45385 and 45387.

It'll soon become harder to bill for anal incision code 46060 and excision codes 46258, 46262, 46270-46288 and repair code 46706. Many of those codes will have 46270-46288 and 46706 as components after July 1. Also, excision code 46220, endoscopy code 46600 and anal fissure curettage/cautery codes 46940-46942 will be components of 46706.

Manipulation codes 45900-45915, anal surgery codes 46040 and 46080 and cyprectomy code 46211 become components of 46706.

A number of digestive surgery codes also became components of omental flap codes 49904-49905, including omentectomy (49255).

CPT code 56821 (Colposcopy of the vulva; with biopsy(s)) became a component of vulvectomy codes 56620-56640. And 57421 (Colposcopy of the entire vagina; with biopsy(s)) became a component of vaginectomy codes 57106-57112 and 57135.