General Surgery Billing and Coding in 2019 – Key Considerations and Challenges

General surgery encompasses a wide range of surgical procedures—from gastrointestinal (GI) tract surgery, kidney, pancreas and liver transplantation, and thoracic and abdominal surgery to breast surgery and elective surgery. With many guidelines that impact code selection, general surgery medical billing and coding can be challenging. In 2019, general surgeons are dealing with 135 ICD-10 code changes and more than 69 CPT updates. Outsourcing medical billing to a company with expert coders and billers can help providers deal with current challenges and ensure accurate reimbursement.

 General Surgery 2019 CPT Code Changes

The CPT Code range for surgery includes codes for fine needle aspiration biopsy, integumentary system, musculoskeletal system, respiratory system, cardiovascular system, hemic and lymphatic systems, mediastinum and diaphragm, digestive system, urinary system, male genital system, reproductive system and intersex, female genital system, maternity care and delivery, endocrine system, nervous system, eye and ocular adnexa, auditory system.

In 2019, there are extensive CPT codes changes for general surgery:

• Fine Needle Aspiration (FNA) biopsy: The new CPT guidelines provide distinct definitions of FNA biopsy and core needle biopsy:
  • Fine needle aspiration (FNA) biopsyis performed when material is aspirated with a fine needle and the cells are examined cytologically
  • Core needle biopsyis typically performed with a larger bore needle to obtain core sample of tissue for histopathologic evaluation

New CPT codes for FNA

The 2019 FNA CPT code changes include 9 new codes (10004-10012), one deleted code (10022) and one revised code (10021).

Deleted: 10022    FNA biopsy with imaging

Revised: 10021    FNA biopsy without imaging, first lesion

 New:

• FNA biopsy, withoutimaging guidance: 10021 first lesion and 10004 for each additional lesion
• FNA biopsy, with ultrasoundguidance: 10005 first lesion and 10006 for each additional lesion
• FNA biopsy, with fluoroscopicguidance: 10007 first lesion and 10008 for each additional lesion
• FNA biopsy, with CTguidance: 10009 first lesion and 10010 for each additional lesion
• FNA biopsy, with MRIguidance: 10011 first lesion and 10012 for each additional lesion

Add-on codes (e.g., +10004) should be listed separately after the primary procedure code (10021).

There are also new CPT guidelines for reporting FNA biopsy.

 

FNA documentation tips: To ensure accurate code assignment, the provider’s documentation must specify the following:

• location of each lesion treated
• complete description of each treated lesion
• the guidance modality (ultrasound, fluoro, CT, MR) for each treated lesion
• Medical necessity for every lesion treated
• Skin Biopsy: In 2019, codes 11100 and 11101 have been deleted and replaced by6 new codes (11102–11107) for skin biopsy. The new codes, which are based on the thickness of the sample and the technique used, are as follows:

11102 Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette) single lesion
+ 11103 each separate/additional lesion (List separately in addition to code for primary procedure)
11104 Punch biopsy of skin (including simple closure, when performed) single lesion
+11105 each separate/additional lesion (List separately in addition to code for primary procedure
11106 incisional biopsy of skin (e.g., wedge) (including simple closure, when performed) single lesion
+11107 each separate/additional lesion (List separately in addition to code for primary procedure

 Points to note:

• Codes 11102–11107 are reported when tissue is obtained exclusively for diagnostic histopathologic examination and is unrelated or distinct from other procedures/services provided in the same operative session.
• The new skin biopsy code set defines three distinct biopsy modalities: tangential, punch, and incisional. For each, there is one code to report the initial biopsy, and a second code to report each additional biopsy.
• Replacement of Gastronomy Tube: The code changes in this category include one deleted code and 2 new codes:

Deleted: 43760 (change of gastrostomy tube, percutaneous, without imaging or endoscopic guidance)

New codes:

 43762  Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; not requiring revision of gastrostomy tract

43763 Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; requiring revision of gastrostomy tract

Code 43762 should be used to report inadvertent G-tube removal (a common complication caused by a confused patient) or removal and replacementof a clogged tube. Code 43763 should be used to report more complicated G-tube replacement. Two examples of such complications are: when the tract is difficult to access, and requires dilation and guidewires to place a new tube or when there is maceration, ulceration, or necrosis of the surrounding skin (http://www.facsbulletin.com).

• Inguinofemoral lymph node excision: Both superficial and deep node(s) are biopsied and/ or excised. The family of lymph node excision codes has got a new code in 2019:

 38531 biopsy or excision of lymph node(s); open, inguinofemoral node(s)

If the procedure is performed bilaterally, modifier 50, Bilateral procedure should be appended to 38531.

• Sentinel lymph node mapping: CPT code 38900 is an add-on code that is used with any lymph node biopsy or lymphadenectomy codeto indicate the intraoperative work done to identify the sentinel lymph nodes. In 2019, the parenthetical following code 38900 has been revised to include codes for primary and staging pelvic and vulvar procedures to the current list of codes.

+38900, Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (list separately in addition to code for primary procedure)

38900 is reported in conjunction with 19302, 19307, 38500, 38510, 38520, 38525, 38530, 38531, 38542, 38562, 38564, 38570, 38571, 38572, 38740, 38745, 38760, 38765, 38770, 38780, 56630, 56631, 56632, 56633, 56634, 56637, 56640).

• Catheter-assisted vein sclerotherapy:In 2019, there is a new code toreport catheter-directed sclerosant ablation using balloon isolation of an incompetent extremity vein:

New Category III code 0524T, Endovenous catheter directed chemical ablation with balloon isolation of incompetent extremity vein, open or percutaneous, including all vascular access, catheter manipulation, diagnostic imaging, imaging guidance and monitoring

This code includes all diagnostic imaging and imaging guidance performed in support of the procedure as well as monitoring of vascular access and catheter manipulation.

• I&D of deep soft tissue abscess: As theAMA/RUC determined that code 20005 as potentially misvalued, it was deleted.

Deleted: Code 20005, Incision and drainage of soft tissue abscess, subfascial (i.e., involves the soft tissue below the deep fascia)

• • Lower extremity multi-layer compression: To prevent miscoding when using code 29581, Application of multi-layer compression system; leg (below knee), including ankle and foot, a parenthetical was added to the CPT code set that instructs not to report 29581 in conjunction with codes for treatment of incompetent veins for the same extremity. Code 29581 should also not be reported for simply wrapping the lower extremity with elastic bandages.
• Appendix L-Vascular families: Appendix L has been updated to explain the order of vessels for arterial and venous vascular branching for catheterization procedures. As the aorta, vena cava, pulmonary artery, or portal vein are considered the starting point of catheterization in this approach, branches have been categorized into first, second, third order, and beyond.

Partnering with a medical billing and coding company specialized in general surgery coding can help surgeons report common general surgery procedures correctly. Expert coders and billers stay abreast with coding changes and can help providers improve claims management and reimbursement.