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 Smith, president of Gail I. Smith Consulting, is a nationally recognized coding educator. For most of her career Gail was an associate professor and director of the health information management (HIM) program at the University of Cincinnati and HIM program director at Cincinnati State Technical and Community College. Gail is a currently a consultant with a software company specializing in medical terminologies. Gail has authored several textbooks, including Basic Procedural Terminology and HCPCS Coding published by the American Health Information Management Association (AHIMA).   An advocate for advanced coder training, Gail is the author of several titles for Libman Education including CPT: Introduction to Procedural Coding and two courses on the unique challenge of CPT coding in the pediatric setting: CPT for Pediatrics and CPT for Pediatrics: Advanced Orthopedic Coding. According to Gail: “One cannot possibly teach every coding scenario a coder will experience in their career. That is why coding education needs to focus instead on how to arrive at an accurate and defensible code assignment. It is the difference between learning to fish, and being given a fish. If you learn to code instead of being given answers to memorize, you will be able to arrive at the complete codes more quickly and with greater confidence.”

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.