POEM Procedure Coding Part 1

Question:

How is the POEM procedure reported?

Answer:

The POEM procedure, Peroral Endoscopic Myotomy, had a new code in 2022: 43497,Lower esophageal myotomy, transoral (ie, peroral endoscopic myotomy [POEM]). Before January 1, 2022, it was reported using an unlisted code. Although 43497 is an endoscopic procedure, it has a 90-day global period according to CMS.

*This response is based on the best information available as of 10/19/23.

Reporting Rives-Stoppa with Hernia Repair

Question:

How is a Rive-Stoppa billed with an incisional hernia repair? I’m being told it is a rectus advancement flap and is coded as 15734.

Answer:

Rives-Stoppa is an incisional hernia repair procedure in which mesh or other prosthesis is placed between the rectus abdominis muscle and the posterior sheath. Rives-Stoppa is considered mesh placement, and as of 2023, mesh placement is included with all hernia repairs.

It is incorrect to report 15734 for a standard Rives-Stoppa repair. Code 15734 may be reported only when musculofascial flaps are created by myofascial release.

Source: ACS Bulletin April

*This response is based on the best information available as of 10/5/23.

Billing a Cholangiogram with ICG Dye

Question:

Can I report code 47563 when indocyanine green (ICG) dye is injected and then I use minimally invasive fluorescent imaging to view structures during dissection?

Answer:

No, it would not be correct to report code 47563 for this clinical scenario. Instead report code 47562,Laparoscopy, surgical; cholecystectomy. Although evaluation using fluorescent imaging may help to visualize structures, it does not confidently demonstrate choledocholithiasis, show the intrahepatic branches or see drainage into the duodenum like a traditional cholangiogram. It also does not include the additional work inherent to code 47563, including placement of a cholangio catheter, injection of radiographic contrast material while viewing the imaging monitor or review of plane films placed under the patient and exposed.

*This response is based on the best information available as of 08/17/23.

Lysing Adhesions

Question:

The patient had extensive adhesions that had to be lysed. Is it appropriate to report 44005, enterolysis (freeing of adhesion), along with the code for the primary surgery?

Answer:

No, 44005 enterolysis (freeing of adhesions) for an open procedure and 44180, Laparoscopic enterolysis, are both designated as “separate procedures.” They are considered integral to the primary procedure at the same anatomic site. Appending a modifier 22 would be appropriate to reflect the additional work performed.

Source: ACS Bulletin November 2019

*This response is based on the best information available as of 08/03/23.

Billing a Right Colectomy with a Diverting Loop Ileostomy

Question:

How is a right colectomy with a loop ileostomy reported?

Answer:

A loop ileostomy with a right colectomy is reported with 44160 (open) or 44205 (laparoscopic) and creation of an ileostomy; code 44130 (open) or code 44187 laparoscopic. This reflects the additional work of creating the external opening; the ileostomy.

Source: ACS Bulletin November 2019

*This response is based on the best information available as of 07/20/23.

Billing Two Hernias

Question:

The surgeon performed a laparoscopic repair of an initial strangulated ventral hernia and a laparoscopic repair of an inguinal hernia on the same day. Can the surgeon bill for both procedures?

Answer:

Yes, both procedures can be reported with codes 49592, 49594, or 49596, depending on size, and 49650,Laparoscopy, surgical; repair initial inguinal hernia.Because this code pair does not have a National Correct Coding Initiative edit, modifier 51,Multiple procedures, would be appended to the lower-valued code.

*This response is based on the best information available as of 07/06/23.