Part B Insider (Multispecialty) Coding Alert

Cardiotomy, tube placement and infusion painted into a corner by edits

Many codes that received revisions to their descriptors in the 2004 CPT book also fell under a blizzard of edits in the National Correct Coding Initiative, version 10.0, making them harder to bill with other commonly used codes. For example:

33310 (Cardiotomy, exploratory [includes removal of foreign body, atrial or ventricular thrombus]; without bypass) was revised for 2004 to clarify that the thrombus could be atrial or ventricular. Now the NCCI Edits clarify that 33310 is a component of intrathoracic anesthesia codes 00524-00529. Also, 33315 (... with cardiopulmonary bypass) becomes a component of anesthesia codes 00529-00754.

And 35800 (Exploration for postoperative hemorrhage, thrombosis or infection; neck) becomes a component of anesthesia codes 00796-00830, while 35820 (... chest) becomes a component of 00830-00848. Code 35840 (... abdomen) becomes a component of 00851-00866, and 35860 (... extremity) becomes a component of 00868-00882. Code 36000 (Introduction of needle or intracatheter, vein) becomes a component of 00902-00952. A number of other codes become components of various anesthetic codes, including:

cardiovascular surgery 36002-36015

venipuncture codes 36400-36410, 36420-36440

venous access codes 36550-36578 and 36596

arterial puncture codes 36600-36640, and open arteriovenous fistu-la revision code 36832

transcatheter procedures codes 37201-37202, 37205, 37207 and 37209.

Also, CPT code 20926 (Tissue grafts, other) becomes a component of a number of anesthesia codes, 00218-00452. Code 22305 (Closed treatment of vertebral process frac-ture[s]) becomes a component of anesthesia codes 00452-00454, and 22310 (Closed treatment of vertebral body fracture[s], without manipulation, requiring and including casting or bracing) becomes a component of 00454.

43752 (Naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance [includes fluoroscopy, image documentation and report]). This code descriptor was revised for 2004 to state that tube placement requires a physician's skill, and to clarify that fluoroscopy is included. Medicare also assigned a nonfacility relative value unit of 0.26 to 43752, which previously lacked an RVU.

Even though 43752 is now billable to Medicare, it's not reportable with various critical care services, according to the CPT manual.

And now the NCCI bundles 43752 as a component of a number of codes. These include obstetric anesthesia codes 01958-01969, organ-harvesting support code 01990, integu-mentary surgery codes 10060-10061, excision and debridement codes 11040-11044, new bone tumor ablation code 20982, new hyoid suspension code 21685, percutaneous vertebroplasty codes 22520-22521, new lateral extracavitary approach codes 22532 and 22533, elbow arthrography code 24220, wrist arthrography code 25246, hip arthrography codes 27090-27096, knee arthrography code 27370, ankle arthrography code 27648, endoscopy codes 31623-31624 and 31643, thoracoscopy codes 32601-32665, cardiac tumor excision codes 33120-33130, pacemaker insertion codes 33206-33211, 33214-33220 and 33226, 33234-33235, 33249, cardiac repair codes 33300-33305, 33320-33335, cardiac codes 33400-33960, 33967-33980, new endovascular repair code 34805, endovascular repair codes 34830-34832, new bypass graft codes 35510, 35512, 35522, 35525, new arterial transposition code 35697, catheter introduction code 36200, and new central venous access device code 36555.

Also, new code 64517

(Injection, anesthetic agent; superior hypogastric plexus) becomes a component of 43752.

New codes 65780 (Ocular surface reconstruction; amniotic membrane transplantation), 65781 (... limbal stem cell allograft) and 65782 (... limbal conjuctival auto-graft) come in for a lot of edits as well. Therapeutic infusion and injection codes 90780-90782 become components of 65780. Injection codes 90782-90784 become components of 65781. And injection codes 90784-90788 and psychotherapy codes 90801-90805 become components of 65782.