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Legislative Updates From SAGESCPT Changes for 2002Eric Weiss, MD Introduction As many of you are aware I am an Advisor to the CPT Editorial Panel of the AMA which creates and manages CPT coding for CMS and most 3rd party payors. I represent SAGES, the Society of American Gastrointestinal and Endoscopic Surgeons in this position. 10 days ago, the 4th quarter CPT meeting took place in San Diego and I have received the 2002 CPT book early which contains revisions, deletions and most importantly new codes that can be used beginning on January 1, 2002. I will try to go through the CPT book and list those codes which are new for 2002 in relation to the surgical specialties. If you are interested in the RVUs that these new codes and all CPT codes have as of January 2002 you can go to the CMS web site at http://www.cms.hhs.gov. Click on "Professionals" then go to the heading "Physicians and Health Care Professionals" and then to "Medicare Coding and Payment Systems". Then select "Physician Fee Schedule". This will allow you to view and download an Excel spreadsheet with the RVUs. There are numerous revision codes that are present which are not listed. Some of these revisions will change codes that were once used to describe other procedures. These revised codes are noted in the CPT book by filled in triangles. I would encourage all to review these new codes and the revised codes when you get the new CPT books. These new codes should be added to your respective charge tickets for use in 2002. Evaluation and Management Services Patient transportation codes now exist that allow one to bill for physician presence during an interfacility transport of critically ill patients. 2 codes exist 99289 and 99290. 99289 is for the first 30-74 minutes and 99290 is an add on code for each additional 30 minutes of transport time. If any procedures or services are provided on the same date of the transfer they may be billed individually. Surgery-General 2 new codes for fine needle aspiration have been added. These are 10021 and 10022. 10021 is fine needle aspiration of any area and 10022 is the same with imaging guidance. Image guided breast biopsies should still be reported using 19102 and 19103 Integumentary System 3 new codes were added for the insertion and removal of drug delivery implants. The codes are 11981, 11982 and 11983. Surgery Musculoskeletal-Introduction/Removal 4 new codes to clarify and describe specific points of injection of (local anesthetic:corticosteroid). 20525, Injection, therapeutic, carpal tunnel. Codes 20551, 20552 and 20553 are clarifications of code 20550. 20551, tendon insertion/origin, 20552 single or multiple trigger point(s), one or two muscle groups and 20553 single or multiple trigger point(s), three or more muscle groups. Surgery Musculoskeletal-Humerous/Upper Arm 6 new codes in the repair, revision, and/or Reconstruction subheading have been added. 24300, Manipulation, elbow, under anesthesia. 24332, Tenolysis, triceps. 24343, Repair lateral collateral ligament, elbow, with local tissue. 24344, Repair lateral collateral ligament, elbow, with tendon graft(includes harvesting graft). 24345, Repair medial collateral ligament, elbow, with local tissue. 24346, Repair medial collateral ligament, elbow, with tendon graft(includes harvesting graft). Surgery Musculoskeletal-Forearm/Wrist 3 new codes were added in the Incision subheading. 25001, Incision, flexor tendon sheath, wrist(eg, flexor carpi radialis). 25024, Decompression fasciotomy, forearm and/or wrist, flexor AND extensor compartment; without debridement of nonviable muscle and/or nerve. 25025, … with debridemnt of nonviable muscle and/or nerve. 1 new code was added in the Introduction or Removal subheading. 25259, Manipulation, wrist, under anesthesia. 4 new codes were added in the Repair, Revision, and/or Reconstruction subheading. 25275, Repair, tendon sheath, estensor, forearm and/or wrist, with free graft(includes obtaining graft)(eg, for extensor carpi ulnaris subluxation). 25394, Osteoplasty, carpal bone, shortening. 25430, Insertion of vascular pedicle inot carpal bone(eg, Harii procedure). 25431, Repair of nonunion of carpal bone(excluding carpal scaphoid(navicular))(includes obtaining graft and necessary fixation) each bone. Surgery Musculoskeletal-Hand and Fingers 1 new code in the Repair, Revision, and/or Reconstruction subheading was added. 26340, Manipulation, finger joint, under anesthesia, each joint. Surgery Musculoskeletal, Application of Casts and Strapping-Body and Upper Extremity 1 new code was added under the casts subheading, 29086, Application, cast: figure-of-eight, finger(eg, contracture). Surgery Musculoskeletal-Endoscopy/Arthroscopy 8 codes have been added in this section. 29805, Arthroscopy, shoulder, diagnostic, with or without synovial biopsy(separate procedure). 29806, Arthroscopy, shoulder, surgical: capsulorrhaphy. 29807, Arthroscopy, shoulder, surgical: capsulorrhaphy, repair of slap lesion. 29824, Arthroscopy, shoulder, surgical: capsulorrhaphy, distal claviculectomy including distal articular surface(Mumford procedure). 29900, Arthroscopy, metacarpophalangeal joint, diagnostic, includes synovial biopsy. 29901, Arthroscopy, metacarpophalangeal joint, surgical; with debridement. 29902, Arthroscopy, metacarpophalangeal joint, surgical; with reduction of displaced ulnar collateral ligament(eg, Stenar lesion). 29903, Unlisted procedure, arthroscopy. Surgery, Cardiovascular System 3 new codes in the Cardiac Assist subheading have been added. 33967, Insertion of intra-aortic balloon assist device, percutaneous. 33979, Insertion of ventricular assist device, implantable intracoporeal, single ventricle. 33980, Removal of ventricular assist device, implantable intracoporeal, single ventricle. 2 new codes under Adjunct Techniques have been added. Both are add on codes. 35685, Placement of vein patch or cuff at distal anastomosis of bypass graft, synthetic conduit (list separately in addition of code for primary procedure). 35686, Creation of distal arteriovenous fistula during lower extremity bypass surgery(non-hemodialysis) (list separately in addition of code for primary procedure). 1 new code under the subheading Intravenous has been added. 36002, Injection procedures(eg, thrombin) for percutaneous treatment of extremity pseudoaneurysm. 1 new code under the subheading, Hemodialysis Access, Intervasculr Cannulation for Extracorporeal Circulation, or Shunt Insertion. 36820, Arteriovenous anastomosis, open; by forearm vein transposition. Surgery, Digestive System-Esophagus 2 new codes under the Repair subheading have been added. 43313 and 44314, both for congental repairs of esophageal defects. Surgery,Digestive System-Intestines(Except Rectum) 3 new codes have been added to the laparoscopy subheading. 44202 had been revised and now represents Laparoscopic entrectomy, resection of small intestine, single resection and anastomosis. 44203, which is an add on code, each additional small intestinal resection and anastomosis(list separately in addition of code for primary procedure). 44204, Laparoscopic colectomy, partial, with anastomosis. 44205, Laparoscopic colectomy, partial, with removal of terminal ileum with ileocolostomy. 1 new code in the excision subheading was added. 45136, Excision of ileoanal reservoir with ileostomy. Surgery,Digestive System-Rectum 1 new code under the subheading of Other procedures was added. 46020, Placement of Seton. Surgery,Digestive System-Liver 5 new codes have been added under the subheadings of laparoscopy and Other procedures to describe treatment of liver tumors by ablative rather then resective procedures. 47370, Laparoscopy, surgical, ablation of one or more liver tumor(s) by radiofrequency. 47371, Laparoscopy, surgical, ablation of one or more liver tumor(s), cryosurgical. 47380, Ablation, open, of one or more liver tumor(s); radiofrequency. 47381, Ablation, open, of one or more liver tumor(s); cryosurgical. 47382, Ablation, open, of one or more liver tumor(s); percutaneous, radiofrequency. Surgery, Urinary System-Bladder 1 new code was added in the Endoscopy subheading. 52001, cystourethoscopy with irrigation and evacuation of clots. Surgery, Urinary System-Ureter and Pelvis 1 new code was added 52347, Cystourethroscopy with transurethral resection or incision of ejaculatory ducts. Surgery, Urinary System-Urethra 4 new codes in the subheading Repair were added. 53431, Urethroplasty with tublularization of the posterior urethra and/or lower bladder for incontinence(eg, Tenago, Leadbetter procedure). 53444, Insertion of tandem cuff(dual cuff). 53446, Removal of inflatable urethral/bladder neck sphincter, including pump, reservoir, and cuff. 53448, Removal and replacement of inflatable urethral/bladder neck sphincter, including pump, reservoir, and cuff through an infected field at the same operative session including irrigation and debridement of infected tissue. 1 new code under the Other Procedures subheading was added. 53853, Transurethral destruction of prostate tissue; by water-induced thermotherapy. Surgery, Male Genital System-Penis 3 new codes under the subheading Excision were added. 54162, Lysis or excision of penile, post-circumcision adhesions. 54163, Repair of incomplete circumcision. 54164, Frenulotomy of penis. 1 revision and 7 new codes have been added to the repair subheading. 54405 has been revised to read, Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders and reservoir. 54406, Removal of all components of a multi-component, inflatable penile prosthesis without replacement of prosthesis. 54408, Repair of component(s) of a multi-component, inflatable penile prosthesis. 54410, Removal and replacement of all components of a multi-component, inflatable penile prosthesis at the same session. 54411, Removal and replacement of all components of a multi-component, inflatable penile prosthesis through an infected field at the same operative session including irrigation and debridement of infected tissue. 54415, Removal of non-inflatable(semi-rigid) or inflatable(self contained) penile prosthesis, without replacement of prosthesis. 54416, Removal and replacement of non-inflatable(semi-rigid) or inflatable(self contained) penile prosthesis at the same operative session. 54417, Removal and replacement of non-inflatable(semi-rigid) or inflatable(self contained) penile prosthesis through an infected field at the same operative session including irrigation and debridement of infected tissue. Surgery, Female Genital System-Vagina 1 new code under the Introduction subheading was added. 57155, Insertion of uterine tandems and/or vaginal ovoids for clinical brachytherapy. Surgery, Female Genital System-Corpus Uteri 1 new code under the Introduction subheading was added. 58346, Insertion of Heyman capsules for clinical brachytherapy. Surgery, Nervous System 2 new codes have been added under the Neurostimulator(peripheral nerve) section. 64561, Percutaneous implantation of neurostimulator electrodes; sacral nerve(transforaminal placement). 64581, Incision for implantation of neurostimulator electrodes; sacral nerve(transforaminal placement). 3 new codes in the Excision, Sympathetic Nerves section were added. 64821, Sympathectomy; radial artery. 64822, Sympathectomy, ulnar artery. 64823, Sympathectomy, superficial palmar arch. 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