Tag Archives | Md Facs

Switch to 43327, 43328 for Esophagogastric Fundoplasty

Open or laparoscopic, through chest or abdominal wall, with or without hiatal hernia repair, with or without mesh … these are the various ways your surgeon might perform an esophagogastric fundoplasty. And these are the factors you’ll need to take into account when you try to pick the proper code(s) from among nine new choices in CPT 2011.

Let our experts show the way with four how-to tips for paraesophageal hiatalhernia repair and fundoplication coding for 2011.

Tip 1: Understand Pathophysiology

“When a patient is described as having a hiatal hernia, it usually means that part of the stomach has herniated through the opening in the diaphragm [esophageal hiatus] into the chest and is usually associated with esophageal reflux disease,” according to Gary W. Barone, MD, a physician and associate professor at the University of Arkansas for Medical Sciences in Little Rock.

The hernia repair typically involves the surgeon reducing the stomach back into the abdomen and suturing the enlarged diaphragmatic hiatus, explains M. Tray Dunaway, MD, FACS, CSP, a general surgeon and an educator with Healthcare Value Inc. in Camden, S.C.

During the fundoplication procedure, such as Nissen, the surgeon additionally wraps part of the fundus (top) of the stomach around the esophagus and sutured in place. This creates a “valve” that allows food to reach the stomach from the esophagus but prevents reflux back to the esophagus.

“I would say the Nissen fundoplication is the most common surgical procedure to treat gastroesophageal reflux disease (GERD),” Dunaway adds. Watch for gastroplasty: Sometimes the esophagus is shortened and the surgeon can’t reduce the hernia. “The surgeon might perform a gastroplasty, forming a tube of stomach to effectively elongate the distal esophagus,” Dunaway says. An example of such a procedure is a Collis gastroplasty.

Tip 2: Use 43332-43337 for Open…

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Make Sure To Check CCI Before You Use The New 2011 Codes

Capture additional pay by separating wound care management codes 97597-97602 from the newly revised debridement codes.

Every year, just when you’re trying to get used to new CPT codes, the Correct Coding Initiative (CCI) comes along and limits how and when you can use the new codes you’ve been given. This year is no exception with CCI 17.0 adding edits involving new Renessa and posterior tibial neurostimulator (PTNS) codes, among others.

The CCI released version 17.0, revealing 19,822 new active pairs and 9,778 code pair deletions, said Frank D. Cohen, MPA, MBB, senior analyst with The Frank Cohen Group, LLC, in a Dec. 14 announcement.

Many of the new code pair additions involve CPT codes that debuted on Jan. 1, 2011 with CCI getting ready to halt payment if you report certain procedures together. Get a grip on the new bundles with this urology-focused rundown.

CPT 2011 deleted Category III code 0193T (Transurethral, radiofrequency microremodeling of the female bladder neck and proximal urethra for stress urinary incontinence), replacing it with a new Category I code 53860 with the same descriptor. CCI targets 53860 with several edits.

When your urologist performs the Renessa procedure, you’ll report 53860, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook.

As of Jan. 1, when 53860 became an active code, CCI 17.0 created edit pairs with the following column 2 codes that Medicare considers usual and necessary parts of any surgery:

  • Venipuncture, IV, infusion, or arterial puncture services represented by codes 36000, 36400- 36440, 36600-36640, and 37202
  • Naso- or oro-gastric tube placement (43752)
  • Bladder catheterization (51701-51703).

“In general CPT code 53680 would include catheter placement for temporary postoperative urinary drainage at the conclusion of the procedure, and therefore, these latter…

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Clear The Smoke On Debridement And Active Wound Care Codes

Confused about when to choose a debridement code and an active wound code? CPT 2011 is here to your rescue with revised debridement code guidelines that clarify how to choose between the two code groups — and the key word that will tighten up your coding is depth.

“Depth is the only documentation item you need to determine the correct code,” explained Chad Rubin, MD, FACS, AMA Specialty Society Relative Value Scale Update Committee (RUC) Alternate Member with Albert E. Bothe, Jr. MD, FACS, American College of Surgeons, AMA CPT Editorial Panel Member at their joint presentation “General Surgery” at last month’s CPT Symposium in Chicago.

Active wound care, which has a 0 day global period, is for active wound care of the skin, dermis, or epidermis. For deeper wound care, use debridement codes in the appropriate location.

Example: Codes 11040 (Debridement; skin, partial thickness) and 11041 (…full thickness) have been deleted. The parenthetical note under the codes’ deletion reads, “For debridement of skin, i.e., epidermis and/or dermis only, see 97597, 97598.” The codes are revised for 2011 to reflect this change. For instance, the revision for code 11042 (Debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq cm or less) removes “Skin, and” and adds after subcutaneous tissue “includes epidermis and dermis, if performed.”

Code 97597 is revised to (Debridement [e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps], open wound, [e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm], including topical application[s], wound assessment, use of a whirlpool, when performed and instruction[s] for ongoing care, per session, total wound[s] surface area; first 20 sq cm or less]).

Code 97597’s revision involves “mainly rewording to make clear how active wound care is separate from integumentary wound care,” Bothe explained.


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Calculi Coding: Capture Full Pay for Multiple Fragmentations

When your urologist fragments more than one stone located in two different locations within the urinary tract during one operative session, the proper coding might leave you scratching your head: Can you ever report both procedures? If you can, how do you sequence the codes? Tackle these tough questions by reviewing a sample scenario.

Your urologist performs a ureteroscopic laser lithotripsy of a left ureteral stone and lithotripsy of a bladder stone. How should you code these procedure performed during one operative session?

Separately Report Procedures Based on Anatomy

Depending on where the stones are in the urinary tract, you may be able to separately report and be paid for multiple fragmentation procedures during the same session. For a ureteroscopic fragmentation of a ureteral or renal pelvic stone your urologist performs, you’ll report 52353 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy [ureteral catheterization is included]). Remember that 52353 applies to “any type of fragmentation, whether you use a Holmium laser, a Candela laser, a mechanical lithotripsy, or an ultrasonic lithotripter,” says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook. If your urologist also fragments a bladder calculus during the same session, your coding will then depend on the different and separate anatomical location of the stones. Therefore, in the sample scenario, you can separately report those procedures. “We are dealing with two separate portions or parts of the urinary tract – a ureteral stone and a bladder stone,” Ferragamo explains.

According to the Correct Coding Initiative (CCI), codes 52317 (Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small [less than 2.5 cm]) and 52318 (…complicated or large [over 2.5 cm]) are bundled with 52353. Because both bundles have a…

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CCI 16.3: Incorporate Injury Repair, Laparoscopy Bundles to Stay Compliant

Version 16.3 of the National Correct Coding Initiative (CCI) edits initiated many new edit pairs on Oct. 1. You’ll need to get to know new edits affecting your small and large bowl injury repairs, open ureterotomy stentings, and diagnostic laparoscopy coding.

Count Bowl, Splenic Injury Repairs With Main Surgery

If your urologist has to perform a small or large bowl repair for an intestinal injury that occurs during an open urological or urogynecological procedure, you’ll likely be facing a new CCI edit dilemma.

CCI bundles column 2 codes 44602 (Suture of small intestine [enterorrhaphy] for perforated ulcer, diverticulum, wound, injury or rupture; single perforation), 44603 (… multiple perforations), 44604 (Suture of large intestine [colorrhaphy] for perforated ulcer, diverticulum, wound, injury or rupture [single or multiple perforations]; without colostomy), and 44605 (… with colostomy) into many of the procedures in the 50010-57280 range.

Silver lining: These edits have a modifier indicator of “1,” which means you can bypass the edits in some clinical circumstances, using a modifier such as 59 (Distinct procedural service). “These bundles indicate that a repair of an inadvertent small or large bowl injury occurring during urological or urogynecological surgery will be included in the primary procedure under most circumstances and should not be billed separately,” says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook. “If such an injury does occur and is repaired, the surgeon should  check CCI, version 16.3 edits to determine if their primary procedure is involved in these edits.”

If, during a urological procedure such as a difficult left nephrectomy, an inadvertent splenic injury occurs, resulting in an open splenectomy (38100, Splenectomy; total [separate procedure]), a partial splenectomy (38101, … partial [separate procedure]), or a laparoscopic splenectomy (38120, Laparoscopy, surgical, splenectomy)…

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Make Sure You’re Applying Massive Prostate Biopsy, Urethral Dilation Bundlings

Modifier 59 sometimes will rescue your reimbursement.

Just when you’re finally getting a handle on all the 2010 coding changes, here comes round two of the Correct Coding Initiative (CCI) edits. Version 16.1, which took effect April 1, will tie your hands when coding many common urology procedures, including prostate biopsies and urethral dilations.

Heads up: CCI 16.1 includes 2,054 new active pairs and 1,947 modifier changes, says Frank D. Cohen, MPA, MBB, senior analyst with MIT Solutions Inc. in Clearwater, Fla.

“For urology, there will be 78 edit pair additions and two edit pair deletions,” says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook.To ensure you get paid appropriately for your urologist’s services this quarter, here’s the rundown of the most important changes.

Say Goodbye to Biopsy with Several Prostate Procedures

You can no longer report prostate biopsy codes 55700 (Biopsy, prostate; needle or punch, single or multiple, any approach) or 55706 (Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance) with 52630 (Transurethral resection; residual or re-growth of obstructive prostate tissue including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included]). Your payer will reimburse you for 52630 but deny the biopsy codes, and you cannot use a modifier to separate these new edits.

“I have a major issue with the bundling of 55700 and 52630,” laments Alice Kater, CPC, PCS, coder for Urology Associates of South Bend, Ind. Kater says her urologists perform a good number of prostate biopsies transrectally and 55700 is what she uses because the descriptor says “any approach.” When you are performing two separate procedures utilizing two different approaches, how can they be bundled?”

Silver lining: CCI also bundles…

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CPT 2010 Update: Urogynecology Coding

Remember, supervision requirements still apply to new codes.
CPT 2010 brings some big changes to urogynecology coding. Your urodynamics coding — and income — changes drastically as of Jan. 1.
Get to Know These 3 New Complex Cystometrogram Codes
You will have three new urodynamics codes to learn starting Jan. 1. CPT 2010 adds the following codes:
• 51727 — Complex cystometrogram (ie, calibrated […]

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Urology CPT 2010: 3 New Codes, 2 Deletions Change Your Urodynamics Coding

Urodynamics income will go down by half, experts calculate.
You will have three new urodynamics codes to learn starting Jan. 1. CPT 2010 adds the following codes:
• 51727 — Complex cystometrogram (ie, calibrated electronic equipment); with urethral pressure profile studies (ie, urethral closure pressure profile), any technique
• 51728 — … with voiding pressure studies (ie, bladder voiding pressure), any technique
• 51729 — … […]

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2010 Tumor Excision Coding: Lesion Vs. Chunk Size

Straight from the AMA in Chicago — answers to your lesion excision coding questions for 2010.
Question: A thigh lesion measures 2 cm but requires a resection down to the subcutaneous layer of 4 cm. Which lesion excision code should I use?
Answer: “You should use the larger of the subcutaneous codes,” says Albert E. Bothe, Jr, […]

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