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.
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.