Learn surgery CPT code changes in Gastroenterology (GI), Neurology, Ophthalmology and Urology specialties.

Current Procedural Terminology (CPT) 2015 update by American Medical Association (AMA) includes 276 new codes. There are a total of 129 revised codes and 137 deleted codes.

New Surgery CPT Codes were added to the Gastroenterology (Digestive System subsection), Neurology (Nervous System subsection), Ophthalmology (Eye and Ocular Adnexa subsections), Urology (Urinary System subsection), Musculoskeletal System and Cardiovascular System subsections.

Additional changes noted in the CPT Surgical Package Definition appear in the Surgical Guidelines to include the new language "or other qualified health care professional who performs the surgery" in the descriptor of provider of services.

GI, Neurology, Ophthalmology, Urology Surgery CPT Codes Changes

We have already covered all Cardiology/ Cardiovascular CPT Code Changes in detail. In this post, we have highlighted the new, revised and deleted CPT codes for for Gastroenterology, Neurology, Ophthalmology and Urology in the following:

Gastroenterology (GI) Surgery CPT Codes Changes

New notes were added to Endoscopy, Small Intestine, including a note advising, “When bleeding occurs as the result of an endoscopic procedure the control of the bleeding is not reported separately during the same operative session.”

A new subheading for Endoscopy, Stomal was added this year. New notes provide guidance on coding when the intended procedure is unable to be completed. These notes also address the correct code assignment when reporting colonoscopy through a stoma. Ten new codes were added in this area: 44381, 44384, 44401-44408. They include codes for balloon dilation, placements of stents, ablation of tumors, mucosal resection, injection procedures, and decompression all conducted through a stoma.

Under the Endoscopy subheading additional notes and clarification was added for coding the extent of the procedure. A valuable new tool has been added in the form of a colonoscopy decision tree. Eight new codes were included this year. Two of the new codes replaced deleted codes.

Several of the new codes replaced deleted codes and added the terms “includes pre- and post-dilations and guide wire passage, when performed.” There are new codes for band ligations as well (45350, 45398).

Two new anoscopy codes—46601, 46607—were added to capture the use of high-resolution magnification (HRA).

Finishing up the new codes added in the Surgery Section, Digestive System Subsection in the Subheading of Other Procedures is a new code to represent Ablation of one or more liver tumor(s) by percutaneous cryoablation, 47383.

New CPT Codes for Esophagus (Endoscopic Procedure)

43180Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus (eg, Zenker’s diverticulum), with cricopharyngeal myotomy, includes use of telescope or operating microscope and repair, when performed

New CPT Codes for Colonoscopy

45388Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)
45389Colonoscopy; with endoscopic stent placement (includes pre and post-dilation and guide wire passage, when performed)
45390Colonoscopy; with endoscopic mucosal resection
45393Colonoscopy; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed
45398Colonoscopy; with band ligation(s) (eg, hemorrhoids)
45399Unlisted procedure, colon

New CPT Codes for Colonoscopy Via Stoma

44401Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed)
44402Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed); with endoscopic stent placement (including pre and post-dilation and guide wire passage, when performed)
44403Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed); with endoscopic mucosal resection
44404Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed); with endoscopic mucosal resection with directed submucosal injection(s), any substance
44405Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed); with transendoscopic balloon dilation
44406Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed); with endoscopic ultrasound examination, limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures
44407Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed); with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures
44408Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed); with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed

New CPT Codes for Sigmoidoscopy

45346Sigmoidoscopy, flexible;with ablation of tumor(s), polyp(s), or otherlesion(s) (includes pre- and post-dilation and guide wire passage, when performed)
45347Sigmoidoscopy; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)
45349Sigmoidoscopy; with endoscopic mucosal resection
45350Sigmoidoscopy; with band ligation(s) (eg, hemorrhoids)

New CPT Codes for Anoscopy

46601Anoscopy; diagnostic, with high-resolution magnification (HRA) (eg, colposcope, operating microscope) and chemical agent enhancement, including collection of specimen(s) by brushing or washing, when performed
46607Anoscopy; with high-resolution magnification (HRA) (eg, colposcope, operating microscope) and chemical agent enhancement, with biopsy, single or multiple

New CPT Codes for Small Intestine (Endoscopic Procedure)

44381Ileoscopy, through stoma; with transendoscopic balloon dilation
44384Ileoscopy, through stoma; with transendoscopic balloon dilation; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)

New CPT Codes for Ablation Liver Tumors

47383Ablation, 1 or more liver tumor(s), percutaneous, cryoablation

Revised CPT Codes for Esophagoscopy (Endoscopic Procedure)

43194Esophagoscopy, rigid, transoral; with removal of foreign body(s
43197Esophagoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing when performed (separate procedure)
43215Esophagoscopy; with removal of foreign body(s)
43216Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps.
43247Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s)
43250Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s); with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps.

Revised CPT Codes for Small Intestine Endoscopy

44360Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
44363Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure); with removal of foreign body(s)
44380Ileoscopy, through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
44385Endoscopic evaluation of small intestinal pouch (eg, Kock pouch, ileal reservoir [S or J]); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
44386Endoscopic evaluation of small intestinal pouch (eg, Kock pouch, ileal reservoir [S or J]); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure); with biopsy, single or multiple
44799Unlisted procedure, small intestine

Revised CPT Codes for Colonoscopy Via Stoma

44388Colonoscopy through stoma; diagnostic,including collection of specimen(s) by brushing or washing, when performed (separate procedure)
44390Colonoscopy through stoma; diagnostic,including collection of specimen(s) by brushing or washing, when performed (separate procedure); with removal of foreign body(s)
44391Colonoscopy through stoma; diagnostic,including collection of specimen(s) by brushing or washing, when performed (separate procedure); with control of bleeding, any method
44392Colonoscopy through stoma; diagnostic,including collection of specimen(s) by brushing or washing, when performed (separate procedure); with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

Revised CPT Codes for Sigmoidoscopy

45330Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
45332Sigmoidoscopy; with removal of foreign body(s)
45333Sigmoidoscopy; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps
45334Sigmoidoscopy; with control of bleeding, any method
45337Sigmoidoscopy; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed
45340Sigmoidoscopy; with transendoscopic balloon, dilation

Revised CPT Codes for Anoscopy

46600Anoscopy; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

Deleted Code for Gastroenterology (GI)

43350Esophagostomy, fistulization of esophagus, external; abdominal approach
42508Parotid duct diversion, bilateral (Wilke type procedure); with excision of 1 submandibular gland
44383Ileoscopy, through stoma; with transendoscopic stent placement (includes predilation)
44393Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
44397Colonoscopy through stoma; with transendoscopic stent placement (includes predilation)
45339Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
45345Sigmoidoscopy; with transendoscopic stent placement (includes predilation)
45355Colonoscopy, rigid or flexible, transabdominal via colotomy, single or multiple
45383Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
45387Colonoscopy; with transendoscopic stent placement (includes predilation)
45378Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
45379Colonoscopy; with removal of foreign body(s)
45380Colonoscopy; with biopsy, single or multiple
45381Colonoscopy; with directed submucosal injection(s), any substance
45382Colonoscopy; with control of bleeding, any method
45384Colonoscopy; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps
45385Colonoscopy; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique
45386Colonoscopy; with transendoscopic balloon, dilation
45391Colonoscopy; with endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures
45392Colonoscopy; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures

Neurology/Neuro Surgery CPT Codes Changes

The Spine and Spinal Cord subheading, Injection, Drainage, or Aspiration Category includes the addition of four new codes:
  • 62302, Myelography via lumbar injection, coded according to the spinal region, cervical
  • 62303, Thoracic
  • 62304, Lumbosacral
  • 62305, Two or more regions
Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System, Introduction/Injection Category includes four new codes to capture Transversus abdominis plane blocks, unilateral (64486-64487) or bilateral (64488-64489).

New Neurology CPT Codes

62302Myelography via lumbar injection, including radiological supervision and interpretation; cervical
62303Myelography via lumbar injection, including radiological supervision and interpretation; thoracic
62304Myelography via lumbar injection, including radiological supervision and interpretation; lumbosacral
62305Myelography via lumbar injection, including radiological supervision and interpretation; 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical)
64486Transversus abdominis plane (TAP) block( abdominal plane block, rectus sheath block) unilateral; by injection(s) (includes imaging guidance, when performed)
64487Myelography via lumbar injection, including radiological supervision and interpretation; by continuous infusion(s) (includes imaging guidance, when performed)
64488Myelography via lumbar injection, including radiological supervision and interpretation; bilateral
64489Myelography via lumbar injection, including radiological supervision and interpretation; by continuous infusions (includes imaging guidance, when performed)

Revised Neurology CPT Codes

61055Cisternal or lateral cervical (C1-C2) puncture; with injection of medication or other substance for diagnosis or treatment
62284Injection procedure for myelography and/or computed tomography, lumbar (other than C1-C2 and posterior fossa)

Deleted Neurology CPT Codes

61334Exploration of orbit (transcranial approach); with removal of foreign body
61440Craniotomy for section of tentorium cerebelli (separate procedure)
61470Craniectomy, suboccipital; for medullary tractotomy
61490Craniotomy for lobotomy, including cingulotomy
61542Craniotomy with elevation of bone flap; for total hemispherectomy
61609Transection or ligation, carotid artery in cavernous sinus; without repair (List separately in addition to code for primary procedure)
61875Craniectomy for implantation of neurostimulator electrodes, cerebellar; subcortical
62116Reduction of craniomegalic skull (eg, treated hydrocephalus); with simple cranioplasty
64752Transection or avulsion of; vagus nerve (vagotomy), transthoracic
64761Transection or avulsion of; pudendal nerve
64870Anastomosis; facial-phrenic

Eye/ Ophthalmology Surgery CPT Codes Changes

Eye/ Ophthalmology changes include Eye and Ocular Adnexa Subsection Changes. Anterior Sclera subheading, Aqueous Shunt Category includes a new code for aqueous shunt to extraocular plate reservoir, 66179, and a revision code, 66184.

New Ophthalmology CPT Codes

66179Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft
66184Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft

Revised Ophthalmology CPT Codes

66180Aqueous shunt to extraocular equatorial plate reservoir, external approach;with graft
66185Revision of aqueous shunt to extraocular equatorial plate reservoir with graft
67399Unlisted procedure, extraocular muscle

Deleted Ophthalmology CPT Codes

66165Fistulization of sclera for glaucoma; iridencleisis or iridotasis
69400Eustachian tube inflation, transnasal; with catheterization
69401Eustachian tube inflation, transnasal; without catheterization
69405Eustachian tube catheterization, transtympanic

Urology Surgery CPT Codes Changes

Two new codes were added in the Vesical Neck and Prostate subheading. Cystourethroscopy with insertion of transprostatic implant single, 52441, and each additional, 52442:
  • 52441 Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant
  • 52442 Each additional permanent adjustable transprostatic implant

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