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CPT gets more specific for gynecologic procedures. (Changes for Skin Lesions as well).

For those wondering about changes in the 2003 Current Procedural Terminology (CPT) codes, look no further than the gynecologic procedure section.

Several changes have been made to the pelvic endoscopy codes, explained Lisa Stavrakas, consultant to the Medical Group Management Association. "New series of codes were created to reflect the focus of the specific anatomic sites involved. Endoscopy codes were added to three subsections of the CPT code set; vulva (56820, 56821), vagina (57420, 57421), and cervix uteri (57452, 57454, 57455, 57456, 57460, and 57461)" said Ms. Stavrakas of Colorado Springs.

The CPT Editorial Panel added similar codes for vaginal colposcopy: 57420 (colposcopy of the entire vagina, with cervix if present) and 57421 (colposcopy of the entire vagina, with cervix if present, with biopsy[s]).

The panel left intact code 57452 (endoscopy of the cervix including the upper/adjacent vagina) but added code 57455, which is the same definition but with cervical biopsy(s) added. Code 57454 (cervical endoscopy with biopsy[s] of the cervix and endocervical curettage) was left intact, but code 57456 (cervical endoscopy with endocervical curettage) was added. "Prior to 2003, code 57454 was an and/or situation," she explained.

Other changes were made in the endoscopy section, Ms. Stavrakas noted. Code 57460 (previously for endoscopy of the cervix including the upper/adjacent vagina with loop electrode excision procedure of the cervix) has been changed to read "endoscopy of the cervix ... with loop electrode biopsy(s) of the cervix." A new code also has been added to this section; code 57461 is for cervical endoscopy with loop electrode conization of the cervix.

The corpus uteri section also contains many changes, mostly reflect the number and the weight of intramural myomas excised by open abdominal, open vaginal, and laparoscopic methods, Ms. Stavrakas said. For example, code 58140, which was previously for "myomectomy, excision of myomata of uterus, single or multiple," has been revised to read "myomectomy, excision of fibroid tumor(s) of the uterus, one to four intramural myoma(s), with a total weight of 250 g or less and/or removal of surface myomas; abdominal approach." Code 58145 is used when the approach is vaginal.

For more numerous tumors, a new code has been added; code 58146 is for "myomectomy of five or more intramural myomas and/or intramural myomas with a total weight greater than 250 g, abdominal approach."

New vaginal hysterectomy codes have been added to differentiate between the size (weight) of the uteri removed by excisional methods and laparoscopic methods:

* 58290 for vaginal hysterectomy of a uterus weighing more than 250 g.

* 58291 for vaginal hysterectomy of a uterus weighing more than 250 g, with removal of tube(s) and/or ovary(s).

* 58292 for vaginal hysterectomy of a uterus weighing more than 250 g, with removal of tube(s) and/or ovary(s), with repair of enterocele.

* 58293 for vaginal hysterectomy of a uterus weighing more than 250 g, with colpourethrocystopexy with or without endoscopic control.

* 58294 for vaginal hysterectomy of a uterus weighing more than 250 g, with repair of enterocele.

Laparoscopic procedures are also addressed in this year's codes. First, code 58550, which used to be for laparoscopic hysterectomy, was revised to read, "laparoscopy, surgical, with vaginal hysterectomy, for a uterus weighing 250 g or less. Five new, specific codes for laparoscopy were also added.

Another change to this year's CPT codes deals with skin lesion removal, said Kent Moore, manager of health care financing and delivery systems at the American Academy of Family Physicians, in Leawood, Kan. Previous codes addressed only the size of the lesion removed, but the new codes also take into account the margin removed along with the lesion.

Mr. Moore uses the example of a 1-cm benign skin lesion that was excised from the patient's back with a margin of 0.2 cm on both sides. Last year, a physician removing such a lesion would have used code 11401; this year the correct code would be 11402. This coding change also applies to codes 11600-11646, he noted.

Although physicians will now get to code at a higher level for removing these lesions, they won't necessarily get paid more, he warned. "The system realizes that people will be coding at higher levels because of descriptor change, so [the committee] went through a review of the relative value units for that code. I believe they are going to reduce the value of the relative value units attached to those codes to account for the fact that there will be appropriate upcoding based on the changes in the descriptors."

That makes it even more important to code excisions correctly, Mr. Moore added. "If you code properly, it will be a wash, but if you're still coding the old way, you will be underpaying yourself."

Another important change concerns codes for blood collection, he continued. The routine venipuncture code, 36415, which used to include finger, heel, and ear sticks, now includes only venipuncture. Code 36416 should now be used for capillary blood specimen collection.
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Title Annotation:Current Procedural Terminology codes
Author:Frieden, Joyce
Publication:Family Practice News
Geographic Code:1USA
Date:Jan 15, 2003
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