Part B Insider (Multispecialty) Coding Alert

Published on Sun Oct 22, 2006 PDF

But you can stop using an unlisted code for gastric electro stimulation

It looks as though your surgeon can't bill for a colectomy with renal mucosectomy, unless he performed a protectomy at the same time. CPT 2007 deletes two codes (44152-44153) for a colectomy without protectomy but with a renal mucosectomy, with or without a loop ileostomy--and replaces them with two new codes, for a colectomy with protectomy, including both loop ileostomy and rectal mucosectomy, when the doctor performs one.  Also, CPT 2007 changes the de-scriptor for colectomy with protectomy code 44211 to clarify that it in-cludes a rectal mucosecotomy. -A rectal mucosectomy is time consuming and not everybody does it,- says surgeon M. Trayser Dunaway, CEO and chief strategic futurist with Health Care Value in Camden, SC.

More: CPT 2007 adds two laparoscopy codes for insertion and revision of an intraperitoneal cannula or catheter (49324-49325). There are also codes for insertion of a subcutaneous extension to an intraperitoneal cannula or catheter (49435), and a delayed creation of an exit site for an embedded subcutaneous segment (49436). You-d likely use these when your surgeon creates a ventriculoperitoneal shunt to siphon extra fluid from the patient's brain ventricles into the peritoneum, says Dunaway.

Also, there's a new add-on code for laparoscopic omentopexy (49326) that you-ll likely use when your surgeon drags a piece of omentum upward to cover up an incision and avoid adhesions, says Dunaway. People have long been wanting to bill for this extra work, he adds.

GES: A cutting edge treatment, gastric electro stimulation (GES), has two new codes, for laparoscopic (43647-43648) implantation/ replacement or revision/removal. Another duo covers the same procedures, only open (43881-43882). In 1999, the Food & Drug Administration approved a GES system called Enterra to treat gastroparesis, which is a disorder in which food moves too slowly through the stomach. Approximately 20 percent of people with type 1 diabetes will develop gastroparesis in their lifetime, according to Sutter Health, which provides GES. Until now, you-ve had to use code 64999 (Unlisted procedure, nervous system) along with upper GI endoscopy code 43235, neurostimulator insertion code 64590 and electronic analysis code 95970. Having four specific GES codes will make this service much easier to bill for, coding sources say.
 
More new codes:

- You-ll have a new code for ablation therapy for reduction or eradication of one or more pulmonary tumors (32998).

- There's also a code for placement of fiducial markers, dosimeters or other devices in the prostate for radiation therapy guidance (55876).

- And you-ll have a new code for revision (including removal) of a prosthetic vaginal graft through an open abdominal approach.

- There are two codes for resection (tumor debulking) of recurrent malignant ovarian, tubal, primary peritoneal or uterine tumors. One code includes omentectomy (58957) and one includes omentectomy plus pelvic lymphadenectomy and limited paraaortic lymphadenectomy (58958).

- In a couple of months, you-ll be using 82107 to bill for alpha-fetoprotein (AFP) L3 fraction isoform and total AFP. You-ll also be able to use 83698 for lipoprotein-associated phospholipase A2 (Lp-PLA2), and 83913 for -molecular diagnostics; RNA stabilization.-

- You-ll be able to bill for more detection methods, including enzyme immunoassay technique detection of Aspergillus (87305). You-ll have four new codes for DNA/RNA detection of enterovirus (87498), staphylococcus (87640-87641) and streptococcus group B(87653). And you-ll be able to use 87808 to bill for immunoassay detection of trichomonas.

- Intraluminal gastrointestinal tract imaging, such as capsule endoscopy, of the esophagus gained a new code with 91111.

- There's also a new code for computerized corneal topography, unilateral or bilateral (92025).

- You can bill for diagnostic analysis with programming of auditory brainstem implant on an hourly basis, using 92640.

- You can now bill for an intrapulmonary surfactant through an endotracheal tube with 94610. You can also bill for continuous inhalation treatment with aerosol medication for acute airway obstruction, for the first hour (94644) and each additional hour (94645). Another new code, 95012, covers -nitric oxide expired gas determination.-

- There are also new codes for neurofunctional testing during a noninvasive imaging functional brain mapping (96020), genetics and genetic counseling services, for each 30 minutes face-to-face (96040), and whole body integumentary photography (96904).