The American Medical Association (AMA) Current Procedural Terminology (CPT)* code set is updated annually. This article describes CPT 2022 coding changes that are relevant to general surgery and its related specialties.
Defining foreign body and implant
There have been numerous coding questions about whether to report a foreign body removal code or implant removal code when an object is removed from the body. The CPT 2022 code set revises the introductory language in the Surgery Guidelines section to add a new heading and definition to clarify the difference between a foreign body and an implant. The new language is as follows:
An object intentionally placed by a physician or other qualified health care professional for any purpose (eg, diagnostic or therapeutic) is considered an implant. An object that is unintentionally placed (eg, trauma or ingestion) is considered a foreign body. If an implant (or part thereof) has moved from its original position or is structurally broken and no longer serves its intended purpose or presents a hazard to the patient, it qualifies as a foreign body for coding purposes, unless CPT coding instructions direct otherwise or a specific CPT code exists to describe the removal of that broken/moved implant.
The Integumentary System/Repair subsection guidelines have been updated. Prior to 2022, the guidelines stated that simple repair included local anesthesia and chemical or electrocauterization of wounds not closed. This statement was often misinterpreted to mean that simple repair codes may be reported when sutures are not used, but electrocauterization is used. To address this issue, the guidelines have been revised to clarify that chemical cauterization, electrocauterization, or wound closure using adhesive strips as the sole repair material is included in evaluation and management (E/M) services. Furthermore, the guidelines were revised to instruct that hemostasis and local or topical anesthesia are not separately reportable when performed in conjunction with a simple repair.
Peroral endoscopic myotomy
A new code has been added to report a transoral lower esophageal myotomy, also known as a peroral endoscopic myotomy (POEM). Prior to 2022, three codes were used to describe esophagomyotomy using other approaches: thoracotomy (32665), laparoscopy (43279), or open abdominal incision (43330). The new code 43497, Lower esophageal myotomy, transoral (ie, peroral endoscopic myotomy [POEM]), is performed via an endoscope using a peroral approach. An exclusionary parenthetical has also been added that precludes reporting 43497 in conjunction with a myotomy via thoracotomy (32665), with a diagnostic esophagoscopy (43191, 43197, 43200), or with a diagnostic esophagogastroduodenoscopy (43235).
Revision of gastroduodenal anastomosis with reconstruction
Two codes for reporting revision of gastroduodenal anastomosis with reconstruction, without vagotomy (43850) or with vagotomy (43855) have been deleted for 2022. The AMA CPT Editorial Panel identified these codes for deletion because of low or no volume. The ACS did not disagree with the CPT Editorial Panel request to delete these codes because the work related to revision and reconstruction will be variable. The ACS recommends that surgeons consider the specific procedures that are performed and report one or more codes as appropriate.
Percutaneous insertion of gastrostomy tube
New Category III code 0647T, Insertion of gastrostomy tube, percutaneous, with magnetic gastropexy, under ultrasound guidance, image documentation and report, has been established to report percutaneous gastrostomy tube placement with coaptation of orogastric and external magnets using ultrasound guidance. Briefly, this new technology uses a catheter with one magnet that is introduced via the mouth into the stomach and a second magnet placed atop the abdomen, which is attracted to the catheter’s magnet inside the body. Once the magnets are coapted, ultrasound guidance and guidewires are used to complete the gastrostomy tube placement. Note that CPT Category III codes do not have assigned relative value units (RVUs), and eligibility for payment, as well as coverage policy, is determined by each private payor.
Flexible transnasal esophagogastroduodenoscopy
New Category III codes 0652T, Esophagogastroduodenoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure); code 0653T, with biopsy, single or multiple; and code 0654T, with insertion of intraluminal tube or catheter, have been approved for reporting flexible transnasal esophagogastroduodenoscopy (EGD) using a new type of endoscope that allows an EGD to be performed transanally and with a topical anesthetic. For other transnasal EGD services, an unlisted code should be reported as appropriate. CPT Category I unlisted codes and Category III codes do not have assigned relative value units (RVUs), and eligibility for payment, as well as coverage policy, is determined by each individual third-party payor.
A new Category III Uterus Transplantation subsection, new guidelines, and new Category III codes have been added to the CPT 2022 code set for reporting uterus transplantation procedures. Similar to the coding convention for other transplantation services, separate codes are used for obtaining the allograft (0664T-0666T), backbench allograft preparation (0668T-0670T), and allograft implantation (0667T). CPT Category III codes do not have assigned RVUs, and eligibility for payment, as well as coverage policy, is determined by each private payor.
Principal care management services
A new family of CPT Category I codes have been added to the Evaluation and Management/Care Management Services subsection for reporting principal care management (PCM) services. These services are intended to replace the Healthcare Common Procedure Coding System (HCPCS) Category II codes G2064 and G2065 that were established in 2020 to report comprehensive care management for a single high-risk disease per calendar month. With the addition of these new PCM CPT Category I codes, the AMA has established a series of care management services that span from PCM for patients with one complex chronic condition expected to last at least three months to chronic care management (CCM) for patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, to complex chronic care management for patients who meet the requirement of CCM, but take more than 60 minutes per month and require moderate- or high-complexity medical decision-making. PCM may be reported by more than one physician or qualified health care professional (QHP) for the same patient in the same calendar month. For example, a general surgeon may report PCM related to managing a flare-up of Crohn’s disease in the same month that a rheumatologist reports PCM related to managing a flare-up of rheumatoid arthritis.
PCM codes 99424 and 99425 are reported for the first 30 minutes and each additional 30 minutes of management provided personally by a physician or QHP per calendar month. PCM codes 99426 and 99427 are reported for the first 30 minutes and each additional 30 minutes of management per calendar month that is spent by clinical staff supervised by a physician or QHP. PCM services that total less than 30 minutes per calendar month are not separately reportable. Note that the time spent for separately reportable services (for example, an E/M visit) may not be used to report the PCM codes. Each PCM code has specific required elements that must be met in order to report the codes. The ACS advises surgeons to thoroughly review the CPT PCM guidelines, code descriptors, and instructional parentheticals before reporting PCM service codes.
ACS Coding Hotline
As part of the ACS’ ongoing efforts to support Fellows and their practices to submit clean claims and receive proper reimbursement, a coding consultation service—the ACS Coding Hotline—has been established, which Fellows and their practice staff may contact to get answers to questions related to CPT, HCPCS, and International Classification of Diseases-10 coding, as well as other billing-related issues. ACS Fellows are offered five free consultation units (CUs) per calendar year. One CU is a period of up to 10 minutes of coding services time.
Coding education on demand
The ACS is pleased to collaborate with KarenZupko & Associates to offer on-demand coding courses that provide the tools necessary to increase revenue and decrease compliance risk. A workbook supplements the on-demand course, so you can follow along with the instructor as you learn at your own pace—starting and stopping when convenient. You also will be provided online access to the KZA alumni site where you will find additional resources and frequently asked questions and information about correct coding. For more information, access the KZA website at https://www.karenzupko.com/general-surgery.
*All specific references to CPT codes and descriptions are © 2021 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.