Dreaming of a Simpler CPT: Unlisted Procedures

by Gail I. Smith, MA, RHIA, CCS-P

Like many coding professionals, I work with CPT every day. I have accepted the fact that as a code set it is a bit messy and frustrating at times. The updates are often controlled by the individual medical societies and I am not sure any coding professionals are involved. As a result, changes do not reflect the holistic review necessary to make the code set cleaner and more user-friendly. Let’s look at unlisted procedures.

I am still confused by the fact that the code set does not have laparoscopic approaches for commonly performed procedures. For example: A laparoscopic liver biopsy. According to the Society of Laparoendoscopic Surgery, the laparoscopic technique for liver biopsy procedures has been performed for dozens of years. So, we have a procedure that has been performed for many years and still does not have a unique CPT code. Is it because the societies don’t care? Are they using open procedure codes? Is AMA running out of room for codes and does it have a process I don’t understand?

Here is a thought: can we initiate a modifier to identify laparoscopic procedures instead of creating entirely new codes? I am dreaming of a system that has a home procedure code with a modifier system for approach since we can’t seem to keep that portion of the system up-to-date.

In research for this blog, I came across an article from the National Library of Medicine that describes a new technique for liver biopsy called natural orifice transluminal endoscopic surgery (NOTES). NOTES is a surgical technique whereby “scarless” abdominal operations can be performed with an endoscope passed through a natural orifice. Is the CPT code set now going to be two generations behind on approaches?

This is only one procedure; there are many more. A modifier to identify approach would allow the code set to keep up with medical advances as they are embraced by the profession.

We need a system that captures surgical procedures accurately for the purposes of data. Data supports all healthcare decision-making, and we deserve a better system.

How Are CPT Codes Changed?
American Medical Association, the owner of CPT, has an infrastructure that includes an Editorial Panel, consisting of physicians and representatives from professional organizations. The Editorial Panel is responsible for updating and modifying the CPT code book. There are several conditions that must be met before new codes are added to the code set, such as:

  • Commonly performed by many physicians across the country, and
  • Consistent with contemporary medical practice

CPT® Coding: Introduction to CPT Coding
CPT® coding is used by physicians and hospitals to describe medical, surgical, and diagnostic services provided to patients. This foundational course provides an introduction to the CPT coding system, CPT guidelines, and correct coding for hospital outpatient services. Learn more here.

About the Author

Gail Smith, MA, RHIA, CCS-P
Gail I. Smith, President of Gail I. Smith Consulting, is a health care consultant with over 30 years experience in the field of coding, education and health information management (HIM). Gail focuses on ICD-10-CM/PCS education with developing online courses, presenting workshops, and performing documentation reviews. She has authored several coding books for CPT and ICD-10-CM and is an AHIMA approved ICD-10-CM/PCS trainer and Academy faculty member.

3 thoughts on “Dreaming of a Simpler CPT: Unlisted Procedures

  1. Anne Esparza - July 3, 2019 at 4:01 pm

    Great article! I think that your idea of appending a modifier on laparoscopic approaches is genius!

  2. Professor Lisa Hall - July 6, 2019 at 5:27 pm

    Love this article!

  3. Cari Greenwood - July 10, 2019 at 5:30 pm

    I too am amazed at the number of commonly performed procedures that do not have a unique CPT code. For example transcatheter excision of tricuspid valve vegetation by angiovac is a commonly performed procedure with no specific CPT code as CPT only has 5 codes for procedures performed on tricuspid valves and most of those report open procedures. I agree that having a base code with a modifier for approach would be an interesting option for expanding the information that can be reported by the code set.