How Will CCI Version 22.

0 Affect General
Surgery Coding?
By Susan Dooley

Expect bundles, and not necessarily bundles of joy! (Well leave those to the obstetrics specialists.) CMS
bundles infusions, punctures, blocks, heart and lung monitoring, and radiology into the surgical package
as much as possible, especially with Correct Coding Initiative (CCI) version 22.0. Youll want to watch for
pairings of the new CPT 2016 surgical codes with these ancillary services.

CPT Gives New General Surgery Codes, CCI Takes Away Options
Of the 365 updates to CPT for 2016, about 50 apply to general surgery, including new, deleted, and
changed codes. According to the AMA, most of these changes were caused by technological advances in
imaging that improve how surgery is performed, such as better resolution in CT scans, improved
technology for CT-guided biopsies, refinements in positron emission tomography (PET) scans, and the
development of endobronchial ultrasound (EBUS), which allows fine needle aspiration of tiny lung
lesions via bronchoscopy. But with these new codes come new CCI edit pairs affecting them.

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

Watch for Edit Pairs Bundling New Codes

CCI edits affecting general surgery coding bundle new CPT codes like 10035 and +10036; 31652, 31653
and +31654; +37252 and +37253; 39401 and 39402; 47531 through 47544; and 49185 with the following
types of procedures:

Closure codes such as 12001 and 12021 for simple repair, 12031 through 12057 for intermediate
repair, and 13100 through 13153 for complex repair
Venipuncture, IV, infusion, or arterial puncture services represented by codes such as 36400
through 36406; 36420 through 36440; 36600; and 36640
Nasogastric or orogastric tube placement (43752)
Most E/M codes
Many radiology codes such as 76000 and 76001; 76942; 76998; 77002; 77011; and 77021.

The above-listed codes are also bundled with nerve blocks, such as most codes in the range 62310
through 64530, and moderate sedation codes 99148 through 99150. The nerve block pairings and
moderate sedation pairings with the above codes are especially notable because their modifier
indicators are 0, which means you have no way to unbundle these edit pairs under any circumstance.

CCI 22.0 Pairings Limit Your EBUS-Reporting Options

We mentioned above that CPT 2016 brought new coding options for endobronchial ultrasound, a
relatively new, minimally invasive procedure that is used to diagnose lung cancer, lung infections, and
other conditions with symptoms of masses in the chest or enlarged mediastinal and axillary lymph
nodes. There are even EBUS-guided transbronchial needle aspiration (EBUS-TBNA) procedures to help
stage nonsmall cell lung cancer, diagnose sarcoidosis, and mediastinal lymphoma.
Here are CPT 2016s three new EBUS-guided lymph node or lesion sampling codes.

31652, Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with
endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg,
aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures
31653, Bronchoscopy, rigid or flexible 3 or more mediastinal and/or hilar lymph node stations
or structures
+31654, Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with
transendoscopic endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or
therapeutic intervention(s) for peripheral lesion(s) (List separately in addition to code for
primary procedure[s]).

But watch out! In addition to ancillary surgical procedures, CCI 22.0 also keeps you from billing these
new codes with the following procedures:

32440 through 32445, Removal of lung, pneumonectomy

32480 through 32491, Removal of lung, other than pneumonectomy
32501, Resection and repair of portion of bronchus (bronchoplasty) when performed at time of
lobectomy

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

32503 through 32504, Resection of apical lung tumor (e.g., Pancoast tumor), including chest wall
resection, rib(s) resection(s), neurovascular dissection, when performed
32505 through 32506, Thoracotomy.

How About You?

Got any tips for dealing with CCI edits? Write to us.

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Contact Us:
Name: Sam Nair
Title: Associate Director Enterprise Practice
Email: shyamn@codinginstitute.com
Direct: 704 303 8150

Desk: 866 228 9252, Ext: 4813

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com