1. 1 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. CHAPTER 10 GENERAL SURGERY II

2. 2 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Hemic and Lymphatic Systems Subsection DivisionsDivisions –Spleen –General –Lymph Nodes and Lymphatic Channels

3. 3 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Spleen (38100-38200) Spleen easily ruptured, causes massive hemorrhageSpleen easily ruptured, causes massive hemorrhage May require splenectomyMay require splenectomy Splenectomy: total or partialSplenectomy: total or partial (Cont’d…)

4. 4 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Spleen (38100-38200) (…Cont’d) Often done as part of more major procedureOften done as part of more major procedure Bundled into major procedureBundled into major procedure

5. 5 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. General (38204-38242) Codes divided based onCodes divided based on –Aspiration –Biopsy –Harvesting –Transplantation Stem cellsStem cells –Immature blood cells originating in bone marrow –Used in leukemia treatment –Used in leukemia treatment (Cont’d…)

6. 6 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. General (38204-38242) (…Cont’d) Types of stem cells:Types of stem cells: –Allogenic: Close relative –Autologous: Patient’s own

7. 7 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Lymph Nodes and Lymphatic Channels (38300-38999) Two types of lymphadenectomies:Two types of lymphadenectomies: –Limited: Lymph nodes only –Radical: Lymph nodes, submandibular gland, and surrounding tissue Term “complete” same as radical neck dissectionTerm “complete” same as radical neck dissection Lymph nodes in all 5 regions are resectedLymph nodes in all 5 regions are resected(Cont’d…)

8. 8 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. (…Cont’d) Region I—Submental & submandibular groupRegion I—Submental & submandibular group Region II—Upper jugular groupRegion II—Upper jugular group Region III—Middle jugular groupRegion III—Middle jugular group Region IV—Lower jugular groupRegion IV—Lower jugular group Region V—Posterior triangle groupRegion V—Posterior triangle group 38720- is unilateral code38720- is unilateral code(Cont’d…) Lymph Nodes and Lymphatic Channels (38300-38999)

9. 9 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. (…Cont’d) “Modified” radical neck: Removal of all lymph nodes routinely removed by radical neck dissection, while preserving internal jugular vein, spinal accessory nerve, and/or sternocleidomastoid muscle“Modified” radical neck: Removal of all lymph nodes routinely removed by radical neck dissection, while preserving internal jugular vein, spinal accessory nerve, and/or sternocleidomastoid muscle This is unilateral procedureThis is unilateral procedure Lymph Nodes and Lymphatic Channels (38300-38999)

10. 10 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Lymphadenectomies Often bundled into more major procedure (e.g., prostatectomy)Often bundled into more major procedure (e.g., prostatectomy) –Do not unbundle and report lymphadenectomy separately

11. 11 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Endocrine System Subsection 9 glands in endocrine system; only 4 included in subsection9 glands in endocrine system; only 4 included in subsection –Thyroid –Parathyroid –Thymus –Adrenal (Cont’d…) Pituitary and pineal: See Nervous SystemPituitary and pineal: See Nervous System Pancreas: Digestive SystemPancreas: Digestive System Ovaries and testes: Respective genital systemOvaries and testes: Respective genital system

12. 12 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Endocrine System (60000-60699) (…Cont’d) Divided into 2 subheadingsDivided into 2 subheadings –Thyroid Gland –Parathyroid, Thymus, Adrenal Glands, and Carotid Body (Cont’d…)

13. 13 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Endocrine System (60000-60699) (…Cont’d) Carotid body refers to area adjacent to carotid arteryCarotid body refers to area adjacent to carotid artery –Can be site of tumors

14. 14 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Thyroid Gland, Excision (60100-60281) 2 lobes2 lobes Code descriptions often refer toCode descriptions often refer to –Partial or subtotal: Something less than total Removes problem side of gland, isthmus, and majority of opposite lobeRemoves problem side of gland, isthmus, and majority of opposite lobe –Total: All –Lobectomy (Partial) –Total thyroid lobectomy (solitary nodules, follicular adenomas, hot or cold nodules, goiters)

15. 15 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Nervous System Divided anatomicallyDivided anatomically –Skull, Meninges, and Brain –Spine and Spinal Cord –Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System

16. 16 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Skull, Meninges, and Brain (61000-62258) CategoriesCategories –Injection, Drainage, or Aspiration –Twist Drills, Burr Hole(s), or Trephine Meninges—3 layers of connective tissue membranes that surround brain & spinal cordMeninges—3 layers of connective tissue membranes that surround brain & spinal cord(Cont’d…)

17. 17 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Skull, Meninges, and Brain (61000-62258) (…Cont’d) Conditions that require openings into brain to:Conditions that require openings into brain to: –Relieve pressure –Insert monitoring devices –Place tubing –Inject contrast material –Inject contrast material (Cont’d…)

18. 18 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Skull, Meninges, and Brain (61000-62258) (…Cont’d) Craniectomy or Craniotomy category (61304-61576)Craniectomy or Craniotomy category (61304-61576) –Removal of portion of skull, usually as operative site –Codes divided by site and condition

19. 19 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Surgery of Skull Base Category Skull base: Area at base of craniumSkull base: Area at base of cranium –Lesion removal from this area very complex Extensive category notesExtensive category notes Surgical management of lesions in skull baseSurgical management of lesions in skull base Often involve surgeons from different specialties working during same operative sessionOften involve surgeons from different specialties working during same operative session

20. 20 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Surgery of Skull Base Terminology Approach procedure: Used to gain exposure of lesionApproach procedure: Used to gain exposure of lesion Definitive procedure: What is done to lesionDefinitive procedure: What is done to lesion Repair/reconstructive procedure: Reported separately only if extensive repairRepair/reconstructive procedure: Reported separately only if extensive repair

21. 21 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Surgery of Skull Base (61580-61619) Approach procedure and definitive procedure coded separatelyApproach procedure and definitive procedure coded separately (Cont’d…)

22. 22 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Surgery of Skull Base (61580-61619) (…Cont’d) Example:Example: –Removal of an intradural lesion using middle cranial fossa approach –61590 Pre-auricular approach procedure, middle cranial fossa and –61608 Definitive procedure of intradural resection of lesion

23. 23 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Cerebrospinal Fluid (CSF) Shunt (62180-62258) Used to drain fluidUsed to drain fluid Codes describe placement ofCodes describe placement of –Devices –Repair –Replacement –Removal of shunting devices

24. 24 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Spine and Spinal Cord (62263-63746) Codes divided on condition and approachCodes divided on condition and approach Other important coding considerationsOther important coding considerations –Unilateral or bilateral procedures (-50) –Multiple procedures (-51) –Radiologic supervision and fluoroguidance reported separately

25. 25 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Many codes in the nervous system involve conditions responsible for procedureMany codes in the nervous system involve conditions responsible for procedure –Example: abscess, cyst, hematoma, foreign body, tumor, etc., as well as technique used for operation Review CCI editsReview CCI edits Spine and Spinal Cord (62263-63746)

26. 26 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Introduction/Injection of Anesthetic Agent, Diagnostic or Therapeutic (64400-64530) Includes codes for:Includes codes for: –Nerve blocks 64400-64530 –Facet joint injections 64470-64476 –Epidural injections 64479-64484 Used to provide pain reliefUsed to provide pain relief

27. 27 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Eye and Ocular Adnexa (65091-68899) Terminology extremely importantTerminology extremely important –Code descriptions often vary only slightly (Cont’d…)

28. 28 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Eye and Ocular Adnexa (65091-68890) (…Cont’d) Codes divided anatomically, examples:Codes divided anatomically, examples: –Eyeball –Conjunctiva –Anterior Segment –Posterior Segment Some codes specifically for patients previously operated onSome codes specifically for patients previously operated on(Cont’d…)

29. 29 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Eye and Ocular Adnexa (65091-68890) (…Cont’d) Much bundlingMuch bundling –Example: Subheading Posterior Segment, Prophylaxis category notes indicate “The following descriptors intended to include all sessions in defined treatment period.”“The following descriptors intended to include all sessions in defined treatment period.”

30. 30 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Eyeball (65091-65290) Removal of the Eye report:Removal of the Eye report: –Evisceration (65091, 65093) Removal of contents of globeRemoval of contents of globe –Enucleation (65101-65105) Removal of eye, leaving orbital structures intactRemoval of eye, leaving orbital structures intact –Exenteration (65110-65114) Removal of eye, adnexa, part of bony orbitRemoval of eye, adnexa, part of bony orbit Associated skin grafting reported separately (15120/15121, 15260/15261)Associated skin grafting reported separately (15120/15121, 15260/15261)

31. 31 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Removal of Foreign Body (65205-65265) Extensive notesExtensive notes Removal from external or intraocularRemoval from external or intraocular Slit lampSlit lamp –Microscope with high-intensity light source –Focuses long narrow beam of light –Different codes for with/without slit lamp –Example: 65220, foreign body removal without slit lamp; 65222, foreign body removal with slit lamp65220, foreign body removal without slit lamp; 65222, foreign body removal with slit lamp

32. 32 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Anterior Segment (65400-66999) Includes:Includes: –Cornea –Anterior Chamber –Anterior Sclera –Iris, Ciliary Body –Lens –Other Procedures –Posterior segment—vitreous procedures for removal of vitreous humor from eye –If performed from core of vitreous, it is a posterior vitrectomy

33. 33 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Cornea Keratoplasty: Repair of corneaKeratoplasty: Repair of cornea 65710-6575665710-65756 Penetrating keratoplasty: Full thickness of cornea removedPenetrating keratoplasty: Full thickness of cornea removed –Replaced with donor cornea Aphakia: Absence of lens of eyeAphakia: Absence of lens of eye Pseudophakia: Presence of artificial lens after cataract surgeryPseudophakia: Presence of artificial lens after cataract surgery

34. 34 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Anterior Chamber (65800-66030) Paracentesis: Removal of fluidParacentesis: Removal of fluid –Needle inserted into anterior chamber and fluid withdrawn Diagnostic (65800)Diagnostic (65800) Therapeutic (65805-65815)Therapeutic (65805-65815) Goniotomy: Surgical procedure using goniolens to view eye (65820)Goniotomy: Surgical procedure using goniolens to view eye (65820) –Usually for congenital glaucoma Synechiae (adhesions)Synechiae (adhesions) –Posterior synechiae: Adhesions iris to lens –Anterior synechiae: Adhesions iris to cornea

35. 35 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Anterior Sclera (66130-66250) Trabeculectomy ab externo (e.g., 65850)Trabeculectomy ab externo (e.g., 65850) –Involves trabecular meshwork Iris-scleral junction, drains aqueous humorIris-scleral junction, drains aqueous humor –Surgery reshapes or punctures the meshwork as a treatment for glaucoma or trauma

36. 36 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Iris, Ciliary Body (66500-66770) Iridotomy performed for removal of:Iridotomy performed for removal of: –Lesion (66600) –Treatment of glaucoma (66625, 66630) –Laser iridotomy (66761) –Photocoagulation (66762)

37. 37 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Lens (66820-66940) CataractsCataracts –Nuclear cataract: Most common Center of lens (nucleus)Center of lens (nucleus) Due to aging processDue to aging process –Cortical cataract: Forms in lens of cortex and extends outward Common in diabeticsCommon in diabetics –Subcapsular cataract: Forms at back of lens Assigned based on type of procedure performedAssigned based on type of procedure performed –Intracapsular (ICCE) –Extracapsular (ECCE) (Cont’d…)

38. 38 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Lens (66820-66940) (…Cont’d) Removal and lens placement (66830-66990)Removal and lens placement (66830-66990) –Extracapsular cataract extraction (ECCE), partial removal Removes hard nucleus in 1 piece and soft cortex in multiple piecesRemoves hard nucleus in 1 piece and soft cortex in multiple pieces –Intracapsular cataract extraction (ICCE), total removal Removes lens and capsule in 1 pieceRemoves lens and capsule in 1 piece –Phacoemulsification Small incision into eye, introduction of probeSmall incision into eye, introduction of probe High frequency waves fragment cataractHigh frequency waves fragment cataract Lens placed through same small incisionLens placed through same small incision

39. 39 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Eyelid (67700-67999) Blepharotomy (67700)Blepharotomy (67700) –Incision into eyelid for drainage of abscess BlepharoplastyBlepharoplasty –Repair of eyelid –Codes in Integumentary System (15820-15823) –Codes in Eye and Ocular Adnexa (67916, 67917, 67923, 67924) Selection of code depends on technique used for repairSelection of code depends on technique used for repair

40. 40 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Eyelid Modifiers E1-E4E1-E4 E1—upper left eyelidE1—upper left eyelid E2—lower left eyelidE2—lower left eyelid E3—upper right eyelidE3—upper right eyelid E4—lower right eyelidE4—lower right eyelid

41. 41 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Auditory System (69000-69990) Codes divided byCodes divided by –External Ear (69000-69399) –Middle Ear (69400-69799) –Internal Ear (69801-69949) –Temporal Bone, Middle Fossa Approach (69950-69979) –Operating Microscope (69990) Outer and middle ear function is conduction of sound waves through earOuter and middle ear function is conduction of sound waves through ear Inner ear contains structures that receive auditory waves and relay to brainInner ear contains structures that receive auditory waves and relay to brain –Right ear—AD –Left ear—AS –Both ears—AU

42. 42 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Divisions of Auditory System External, middle, and internal earExternal, middle, and internal ear Figure: 10.14

43. 43 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Auditory System Further divisions on procedure:Further divisions on procedure: –Incision –Excision –Removal, ex. foreign body –Repair –Other

44. 44 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. External Ear (69000-69399) Incision: Drainage of abscess or hematomaIncision: Drainage of abscess or hematoma –Simple, 69000 –Complicated, 69005 Excision: BiopsyExcision: Biopsy –External ear, 69100 –External auditory canal, 69105 –Excision of external ear, partial/complete, 69110, 69120

45. 45 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Removal of Foreign Body Based on with/without general anesthesiaBased on with/without general anesthesia –69200, 69205 Impacted cerumenImpacted cerumen –One or both ears –69210

46. 46 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Repair OtoplastyOtoplasty –For protruding ears –May or may not decrease external ear size –Add -50 for both ears CanalplastyCanalplasty –Reconstruction of external auditory canal –Codes based on stenosis or congenital defect –Caution: Canalplasty bundled into some middle ear repair codes For example 69631-69646For example 69631-69646

47. 47 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Middle Ear (69400-69799) Eustachian tube connects middle ear to back of throat for drainageEustachian tube connects middle ear to back of throat for drainage –Fluid collects in middle ear when tube malfunctions –Prevents air from entering middle ear and pressure builds Surgical interventionSurgical intervention –Myringotomy (incision into tympanic membrane) relieves pressure and drains pus –Tympanostomy (incision and placement of PE tube (pressure equalization) repair of eardrum and hearing mechanism Myringotomy included in tympanostomy (tubes)Myringotomy included in tympanostomy (tubes)

48. 48 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Inner Ear, Incision and/or Destruction (69801-69840) Labyrinthotomy: Surgical incision into the cavelike structure (labyrinth) of inner earLabyrinthotomy: Surgical incision into the cavelike structure (labyrinth) of inner ear If pressure builds within labyrinth, may result in:If pressure builds within labyrinth, may result in: –Vertigo –Ringing –Hearing loss, etc. 69801, 69802 = with/without mastoidectomy69801, 69802 = with/without mastoidectomy

49. 49 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Excision (69905-69915) LabyrinthectomyLabyrinthectomy Incus and stapes are removedIncus and stapes are removed Codes are based on approach as:Codes are based on approach as: –Transcanal 69905 –Postauricular (behind ear) 69910

50. 50 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Introduction (69930) Cochlear device ImplantCochlear device Implant Computerized deviceComputerized device Restores partial hearingRestores partial hearing Receiver on outside of skin, behind ear, over the site of transmitterReceiver on outside of skin, behind ear, over the site of transmitter Transmitter implanted under skinTransmitter implanted under skin Sound processor connected to an electrode implanted in cochleaSound processor connected to an electrode implanted in cochlea

51. 51 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Temporal Bone, Middle Fossa Approach (69950-69979) Surgical approach used with:Surgical approach used with: Repair vestibular labyrinth nerves (69950)Repair vestibular labyrinth nerves (69950) Decompress facial nerve (69955)Decompress facial nerve (69955) Decompress internal auditory canal (69960)Decompress internal auditory canal (69960) Removal of neoplasm from temporal bone (69970)Removal of neoplasm from temporal bone (69970)

52. 52 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Operating Microscope (+69990) Used with procedures using microsurgical techniquesUsed with procedures using microsurgical techniques Code in addition to primary procedure performedCode in addition to primary procedure performed –Unless primary procedure description includes microsurgical techniques –Example: 15758 Free fascial flap with microvascular anastomosis –Note that following 15758 is the statement: “(Do not report code 69990 in addition to code 15758)”“(Do not report code 69990 in addition to code 15758)”

53. 53 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Conclusion CHAPTER 10 GENERAL SURGERY II