Part B Insider (Multispecialty) Coding Alert

You won't have to rely on an unlisted code -- and sketchy pay -- after Jan. 1

Do you ever struggle to get an unlisted procedure code paid? CPT 2009 has the cure for one procedure your physician may have been doing if she invested in the latest endoscopy equipment.

CPT provides new codes for when your doctor views inside the bile duct with a camera. It also changes codes for when your physician destroys hemorrhoids with thermal energy.

The latest technology has made it possible for your physician to actually see inside the ducts that carry bile to the small intestine, but until now there hasn't been a code for visualizing with the tiny camera that she'd use. A new code could prove useful for some practices, says Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta.

CPT 2009 catches up with that tiny camera with an add-on code for endoscopic retrograde cholangiopancreatography (ERCP) procedures: +43273 (Endoscopic cannulation of papilla with direct visualization of common bile duct[s] and/or pancreatic duct[s]).

To use this code, your physician will need to perform ERCP, which includes codes 43260, 43261, 43263-43265, and 43267-43272 (Endoscopic retrograde cholangiopancreatography [ERCP] ...).

You'll be looking for evidence in the doctor's notes that she cannulated, entered, or penetrated the papilla of Vater, which is where the bile duct empties into the lower intestine, or that she viewed the common bile duct or pancreatic duct.

You'll have fewer hemorrhoid-destruction codes to rely on with CPT 2009. The AMA deletes 46934-46936 (Destruction of hemorrhoids, any method ...) and adds one new code, 46930 (Destruction of internal hemorrhoid[s] by thermal energy [e.g., infrared coagulation, cautery, radiofrequency]).

A note appended to 46930 announces the demise of the old hemorrhoid destruction codes and refers you to several other codes: "For incision of external thrombosed hemorrhoid(s), use 46083; for destruction of internal hemorrhoids by thermal energy, use 46930; for destruction of hemorrhoid(s) by cryosurgery, use 46999; for excision of hemorrhoid(s), see 46250-46262, 46230; for injection, use 46500; for ligation, see 46221, 46945, 46946; for hemorrhoid-opexy, use 46947."

CPT 2009 appends a lot of notes to various gastroenterology codes, including the following notes that enhance your knowledge of how to report each code:

• 43752 -- Naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance (includes fluoroscopy, image documentation and report)

(Do not report 43752 in conjunction with critical care codes 99291-99292, neonatal critical care codes 99468, 99469, pediatric critical care codes 99471, 99472, or low birth weight intensive care service codes 99478, 99479.)

The above note reflects significant changes in E/M codes for critical, neonatal, and pediatric codes.

• 43882 -- Revision or removal of gastric neurostimulator electrodes, antrum, open (For electronic analysis and programming of gastric neurostimulator pulse generator, see 95980-95982.)

• 45170 -- Excision of rectal tumor, transanal approach

(For transanal endoscopic microsurgical [i.e., TEMS] excision of rectal tumor, use 0184T.)