General Surgery: Wondering Who Can Exactly Perform Surgery? Look at CPT® 2014 for Clarification

Plus, find out how coding for stent placement, removal, or both via ERCP have become simpler, thanks to CPT 2014.

The confusion over whether your general surgeon is limited to performing services from certain sections of CPT® or if other providers can venture into “your” territory was always there; but CPT® 2014 clarifies all that.

Look up new introduction in CPT® 2014

New introduction in CPT® 2014 mentions that healthcare techniques and procedure have evolved in a way that questions the conventional distinction of surgery versus medicine. Therefore, the listing of a service or procedure in a specific section of this book should not be interpreted as strictly classifying the service or procedure as ‘surgery’ or ‘not surgery’, mentions the new CPT® 2014 introduction.

CPT® 2014 also makes coding for Stenting Procedures simpler

2014 CPT® clarifies coding for stent placement, removal or both endoscopic retrograde cholangiopancreatography (ERCP) by introducing three new comprehensive CPT® 2014 codes and deleting two codes that you used previously.

Here are some tips on how you should use these changes and make your reporting of these general surgery procedures simpler.

Strike off these old codes

Prior to January 1, 2014, you used these two codes for reporting ERCP stent placement/removal which have been replaced by three new codes:

·         43268 — Endoscopic retrograde cholangiopancreatography (ERCP); with endoscopic retrograde insertion of tube or stent into bile or pancreatic duct

·         43269 — … with endoscopic retrograde removal of foreign body and/or change of tube or stent.

Learn the new codes

Start learning and using these CPT 2014 codes:

·         43274 — Endoscopic retrograde cholangiopancreatography (ERCP); with placement of endoscopic stent into biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent

·         Notice the new text note that directs you to 43274 for naso-biliary or naso-pancreatic drainage tube placement instead of deleted code 43267.

·         43275 — … with removal of foreign body(s) or stent(s) from biliary/pancreatic duct(s)

·         43276 — … with removal and exchange of stent(s), biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent exchanged.

Remember: List 43274 for each stent, even if they are in the same duct. This is different from the old codes. Use modifier 59 (Distinct procedural service) for each subsequent stent placed.

Likewise, 43276 includes removal and replacement of one stent.

Omission: 43275 represents removal of one or more stents during the same operative session.

Benefits of new codes

The deleted codes did not provide a way to differentiate the service of simply removing a stent versus removing and replacing a stent. However, the three new codes allow you to distinguish between the two. These codes will help you avoid confusion over picking one code for replacement or two codes (one for the removal and the other for insertion).

Know what’s included

Definitions suggest that the new codes 43274 and 43276 are comprehensive and include pre- and post-dilation, guide wire passage, and sphincterotomy, when performed. Even then, see to it that you still separately report radiology for these services. Earlier you used to report comprehensive ERCP stent placement service with code 43268 for the stent, 43262 for the sphincterotomy, and 43271 for the dilation. Now you can report the same service using 43274.

ERCP codes must be used only “if one or more of the ductal system(s) (pancreatic, biliary) is/are visualized. 

Keep a general surgery coding resource handy

Stents are not the only ERCP changes you need to know in 2014.  It’s therefore always helpful to have a general surgery coding resource that alerts you to each code change, interprets how each change will affect your coding, and provides all the strategies, expert insight and practical examples you need to be on the correct side of reimbursement. 

Get Well-Versed with Accidental Foot GSW Story

Get expert wound care answers.

Inaccurately coding wound care claims can result in a breakdown in your bottom line. Go through these wound care questions and answers to decide if your wound medical coding knowledge means a quick reimbursement or necessitates immediate treatment. Read this article for accurate medical coding.

Question #1: In case your podiatrist examines a patient in the ED to treat a hunting gunshot wound in the foot that involves broken metatarsal bones that the podiatrist should repair in the operating room, should you report the tissue or bone injury and repair as the primary diagnosis as well as the procedure?

Answer: A gunshot wound to the foot is actually a high-velocity wound that is likely to have fractures and needs an aggressive washing along with cleaning of the wound owing to contamination from sock and shoe material and dirt.

Based on the condition above, you're also going to have to do multiple debridements.

The rules state you must list things in order with the procedure that makes use of the most time and skill for that needed service first. In this scenario, the debridement of the open compound fracture would take preference, as it's a bigger code in terms of RVUs.

Consequently, for accurate medical coding, you would code the wound as 1101x (Debridement including removal of foreign material at the site of an open fracture[s] and/or dislocation[s]...) associated with diagnosis code 892.1 (Open wound of foot except toe[s] alone; complicated), as well as 28485 (Open treatment of metatarsal fracture, includes internal fixation, when performed, each) related to 825.30 (Fracture of unspecified bone[s] of foot [except toes]; open).

Question #2: What codes should you report for compression therapy for patients who have venous stasis ulcers?

Answer: There's no individual code for compression therapy for venous stasis ulcers because there is for statin therapy. Podiatrists carry out treatment for venous stasis ulcers with a number of modalities according to the situation. For instance the Unna boot, for which you may only report the application of the boot (29580, Strapping; Unna boot), however not the boot itself.

Other modalities involve Ace wraps along with compression markers (HCPCS code A6449, Light compression bandage, elastic, knitted/woven, width greater than or equal to 3 in. and less than 5 in., per yard) as well as Profore, which is a multi-layer compression bandage system.

Medical Coding Tip: Report Profore along with 29580, and then think of appending modifier 22 (Increased procedural services) to explain for the multiple layers that the podiatrist should apply. You must then link the CPT® code to ICD-9 code 454.0 (Varicose veins of lower extremities; with ulcer).

Venous stasis wounds are caused when the veins in the lower leg don't work so well and you get leakage of venous blood and swelling of the legs. The ulcers are a consequence of the poor blood exchange and the swelling.