Lesson

This week we will be covering some subsections of the surgery section of the CPT Manual. It will be important to keep your medical dictionaries and your anatomy and physiology textbooks handy, as you may need to reference these with this week's chapters. It is important that you use the index in the CPT Manual as guide to locate the correct CPT code and never code from the index. The descriptions in the CPT Manual will provide tips regarding the procedure, such as whether the procedure includes contrast, whether the code is an add-on code, or the approach recommended for the procedure. Remember that the surgical global period applies to all areas of the surgery section of the CPT Manual.

If you do not understand the documentation in the medical record, do not code what you do not understand. Always research and ask questions. As a coder it is your responsibility to clarify documentation. This can be done by improving your resource lists, research skills, and most of all by becoming comfortable with asking questions.

Coding for the respiratory system involves a few different areas of the CPT Manual. For example, codes for the throat and mouth could be found in the digestive system whereas codes for pulmonary function studies will be found in the medicine section of the manual. The codes in the respiratory system subsection are divided first by anatomic location and second by procedure. There are different approaches to the surgical procedures in the respiratory system, such as endoscopy, thoracoscopy, thoractomy, thoracoscopy, laryngotomy, sinusotomy, and so forth. There are two types of scopes used in surgical procedures: rigid and flexible. There are different codes for each type. A key fact to remember when coding for surgical scope procedures is that if a diagnostic scope is performed in the same area, it is considered to be bundled into the surgical scope procedure.

There are specific rules to coding surgical procedures, and coding for the respiratory system is no different. Ask the following questions.

• Is applying the correct modifier(s) to further define the service (for example modifier 50, 51, or 52) appropriate?
• Is the approach indirect or direct? External or internal?
• Is the procedure an excision or destruction?
• Was there packing inserted? Anterior, posterior, or balloon?
• Was the scope used rigid or flexible?
• Was the biopsy incisional or excisional?
• Was the scope procedure considered diagnostic or surgical?

The cardiovascular codes can be found in three sections in the CPT Manual. The sections are Surgery, Medicine, and Radiology. The Surgery section contains codes for cardiovascular surgical procedures, the Medicine section contains codes for nonsurgical cardiovascular services, and the Radiology section contains diagnostic studies The procedures in each of these sections can be best described as invasive or interventional, noninvasive, electrophysiology, or angiography.

The Cardiovascular Surgery section can be found in the subsection range 33010–37799 in the Surgery section of the CPT Manual. Cardiovascular surgeries are considered invasive for the most part. Invasive procedures, or interventional procedures, involve breaking the skin. These surgeries can be performed percutaneously or by open surgical approach. Codes from the Cardiovascular System subsection of the Surgery section are divided on the basis of whether the procedure was performed on the heart/pericardium or on arteries/veins.

Services in the Cardovascular subsection of the Medicine section can be either invasive/noninvasive or diagnostic/therapeutic. Some examples of noninvasive services would be an echocardiogram or a rhythm ECG, which can be located in the Medicine section of the CPT Manual in the code ranges 93303–93352 or 93000–93278. A key point to remember when coding for diagnostic procedures is that if the definition of the code is for a global procedure and the physician only performed the interpretation and report for these diagnostic procedures, then modifier 26 should be appended to the CPT code to indicate that only the professional component was performed.

The electrophysiology services involve the review of the heart's electrical system. These procedures include patients who are experiencing some type of an arrhythmia. These are typically noninvasive studies, but the treatment usually is an invasive procedure, such as an insertion of a pacemaker. These procedures can usually involve periodic reporting in order for the data to be collected and analyzed over a period of time.

Nuclear cardiology can be defined as diagnostic services related to the heart. These usually include radiology tests performed with radioactive pharmaceutical contrast. The code description and notes should assist you in determining whether contrast is included in the procedure or whether it should be billed separately. The use of contrasting material in diagnostic procedures is used so that images can be further enhanced to increase visibility of specific areas in the diagnostic study. Most of these diagnostic codes can be found in the radiology section of the CPT Manual in the ranges 75557–75574 and 75600–75791.

As a coder it is important to understand the different types of approach to cardiovascular surgery. These can be very similar to other body areas/systems that we have explored so far with the other sections of the CPT Manual as they relate to surgery. The following are some important questions to ask when coding cardiovascular services.

• Is the procedure invasive or noninvasive?
• Does the procedure involve coronary or noncoronary vessels?
• When a pacemaker is inserted, is the approach epicardial or transvenous?
• How many leads does the inserted pacemaker have?
• Does the procedure involve initial placement, replacement, or repair?
• Where can a coder find the listing of vascular families in the CPT Manual?
• Did the physician perform the interpretation and report or did he or she perform the global procedure?
• Is the catheter placement nonselective or selective?

The hemic, lymphatic, mediastinum, and diaphragm systems involve the following subheadings in the CPT Manual: spleen and general and lymph nodes/lymphatic channels. This can be further defined by the type of procedure, such as excision, incision, repair, aspiration, and so forth. These services can be found in the CPT Manual in the code ranges 38100–39599. The following are some important questions to ask when coding hemic, lymphatic, mediastinum, and diaphragm services.

• Is the lymph node surgery limited or radical?
• What type of surgery is being performed? Laparoscopy? Incision? Excision? Endoscopy?
• Was the procedure performed for staging of cancer?
• Did the bone marrow procedure involve allogenic or autologic bone marrow?
• Was contrast used during the lymph node biopsy?
• Was the lymph node surgery bilateral or unilateral?

Remember, when coding for surgery it is important to answer the following questions.

• Did the physician provide the surgery or did he or she provide the global package?
• If the procedure was discontinued, was it due to patient safety or convenience for the surgeon?
• Does the medical record documentation indicate significant or additional work by the surgeon?
• Were multiple procedures performed? If so, are any of them add-on codes?
• Does the medical records documentation indicate two or more surgeons involved in the surgery? If so, was there a surgical team, co-surgeon, and/or assistant surgeon?

The following activity provides you with an opportunity to test your knowledge about key points from this week's readings.