2021 BILLING AND CODING GUIDE GENERAL SURGERY

2021 BILLING AND CODING GUIDE GENERAL SURGERY

2021 Medicare Physician, Hospital Outpatient, ASC Coding and Payment

Rates listed in this guide are based on their respective site of care- physician office, ambulatory surgical center, or hospital outpatient department. All rates provided are for the Medicare National Average rounded to the nearest whole number for 2021 and do not represent adjustment specific to the provider's location or facility. Commercial rates are based on individual contracts. Providers are encouraged to review contracts to verify their specific contracted allowables. Medtronic products associated with general surgery procedures addressed within this guide do not have a dedicated HCPCS1 level II coding assignment. Providers may choose to report A4649 Surgical supply; miscellaneous for purposes of cost tracking. Medicare considers the use of surgical supplies to be included in the payment for the associated CPT, and no additional payment is allowed.

CPT? CODE2

CODE DESCRIPTION

PHYSICIAN3

AMBULATORY

HOSPITAL

SURGICAL CENTER4 OUTPATIENT4

60540 60545

60650

44950 44955

44960 44970 47562 47563 47564 47600

ADRENALECTOMY Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal (separate procedure)

Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal (separate procedure); with excision of adjacent retroperitoneal tumor Laparoscopy, surgical, with adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal

APPENDECTOMY Appendectomy

Appendectomy; when done for indicated purpose at time of other major procedure (not asseparate procedure) (List separately in addition to code for primary procedure) Appendectomy; for ruptured appendix with abscess or generalized peritonitis

Laparoscopy, surgical, appendectomy

CHOLECYSTECTOMY Laparoscopy, surgical; cholecystectomy

Laparoscopy, surgical; cholecystectomy with cholangiography

Laparoscopy, surgical; cholecystectomy with exploration of common duct

Facility Only: $1,104 Inpatient only, not reimbursed for hospital outpatient or ASC

Facility Only: $1,276 Inpatient only, not reimbursed for hospital outpatient or ASC

Facility Only:$1,222 Inpatient only, not reimbursed for hospital outpatient or ASC

Facility Only: $664 $1,406 Facility Only: $85 N/A for ASC

$3,183

Not separately payable, packaged into payment for other procedures

Facility Only: $905 Facility Only: $622

Inpatient only, not reimbursed for hospital outpatient or ASC

$2,306

$5,060

Facility Only: $682 $2,306 Facility Only: $742 $2,306

$5,060 $5,060

Facility Only: $1,155 $2,306

$5,060

Cholecystectomy

Facility Only: $1,104 Inpatient only, not reimbursed for hospital outpatient or ASC

1

CPT? CODE2

CODE DESCRIPTION

PHYSICIAN3

AMBULATORY

HOSPITAL

SURGICAL CENTER4 OUTPATIENT4

47605 47610 47612 47620 43107 43108 43112 43113 43116 43117

43118

43121 43122 43123

43124

Cholecystectomy; with cholangiography

Facility Only: $1,164 Inpatient only, not reimbursed for hospital outpatient or ASC

Cholecystectomy with exploration of common duct

Facility Only: $1,295 Inpatient only, not reimbursed for hospital outpatient or ASC

Cholecystectomy with exploration of common duct; with choledochoenterostomy

Facility Only: $1,319 Inpatient only, not reimbursed for hospital outpatient or ASC

Cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty, with or without cholangiography ESOPHAGECTOMY Total or near total esophagectomy, without thoracotomy; with pharyngogastrostomy or cervical esophagogastrostomy, with or without pyloroplasty (transhiatal)

Facility Only:$1,424 Inpatient only, not reimbursed for hospital outpatient or ASC

Facility Only:$3,044 Inpatient only, not reimbursed for hospital outpatient or ASC

Total or near total esophagectomy, without thoracotomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation and anastomosis(es)

Total or near total esophagectomy, with thoracotomy; with pharyngogastrostomy or cervical esophagogastrostomy, with or without pyloroplasty

Facility Only: $4,541 Facility Only: $3,558

Inpatient only, not reimbursed for hospital outpatient or ASC

Inpatient only, not reimbursed for hospital outpatient or ASC

Total or near total esophagectomy, with thoracotomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es)

Facility Only: $4,435 Inpatient only, not reimbursed for hospital outpatient or ASC

Partial esophagectomy, cervical, with free intestinal graft, including microvascular anastomosis, obtaining the graft and intestinal reconstruction

Facility Only: $5,077 Inpatient only, not reimbursed for hospital outpatient or ASC

Partial esophagectomy, distal two-thirds, with thoracotomy and separate abdominal incision, with or without proximal gastrectomy; with thoracic esophagogastrostomy, with or without pyloroplasty (Ivor Lewis)

Partial esophagectomy, distal two-thirds, with thoracotomy and separate abdominal incision, with or without proximal gastrectomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es)

Facility Only: $3,326 Inpatient only, not reimbursed for hospital outpatient or ASC

Facility Only: $3,703 Inpatient only, not reimbursed for hospital outpatient or ASC

Partial esophagectomy, distal two-thirds, with

Facility Only: $2,918 Inpatient only, not reimbursed for hospital

thoracotomy only, with or without proximal

outpatient or ASC

gastrectomy, with thoracic esophagogastrostomy,

with or without pyloroplasty

Partial esophagectomy, thoracoabdominal or abdominal Facility Only: $2,609 Inpatient only, not reimbursed for hospital

approach, with or without proximal gastrectomy; with

outpatient or ASC

esophagogastrostomy, with or without pyloroplasty

Partial esophagectomy, thoracoabdominal or abdominal Facility Only: 4,598 Inpatient only, not reimbursed for hospital

approach, with or without proximal gastrectomy; with

outpatient or ASC

colon interposition or small intestine reconstruction,

including intestine mobilization, preparation, and

anastomosis(es)

Total or partial esophagectomy, without reconstruction Facility Only: $3,886 Inpatient only, not reimbursed for hospital

(any approach), with cervical esophagostomy

outpatient or ASC

2

CPT? CODE2

CODE DESCRIPTION

PHYSICIAN3

AMBULATORY

HOSPITAL

SURGICAL CENTER4 OUTPATIENT4

43620 43621 43622 43631 43632 43633 43634 43280 43281 43282 43325 43332

43333

43334 43335

43336

43337

GASTRECTOMY

Gastrectomy, total; with esophagoenterostomy

Facility Only: $2,046 Inpatient only, not reimbursed for hospital outpatient or ASC

Gastrectomy, total; with Roux-en-Y reconstruction

Facility Only: $2,340 Inpatient only, not reimbursed for hospital outpatient or ASC

Gastrectomy, total; with formation of intestinal pouch, any Facility Only: $2,385 Inpatient only, not reimbursed for hospital

type

outpatient or ASC

Gastrectomy, partial, distal; with gastroduodenostomy

Facility Only: $1,496 Inpatient only, not reimbursed for hospital outpatient or ASC

Gastrectomy, partial, distal; with gastrojejunostomy

Facility Only: $2,092 Inpatient only, not reimbursed for hospital outpatient or ASC

Gastrectomy, partial, distal; with Roux-en-Y reconstruction

Facility Only: $1,980 Inpatient only, not reimbursed for hospital outpatient or ASC

Gastrectomy, partial, distal; with formation of intestinal Facility Only: $2,193 Inpatient only, not reimbursed for hospital

pouch

outpatient or ASC

REPAIR OF DIAPHRAGMATIC HERNIA (HIATAL HERNIA)

Laparoscopy, surgical, esophagogastric fundoplasty (eg, Facility Only: $1,113 $3,794 Nissen, Toupet procedures)

$8,908

Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; without implantation of mesh

Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantation of mesh

Esophagogastric fundoplasty; with fundic patch (Thal-Nissen procedure)

Facility Only: $1,588 $3,794

$8,908

Facility Only: $1,785 $3,794

$8,908

Facility Only: $1,403 Inpatient only, not reimbursed for hospital outpatient or ASC

Repair, paraesophageal hiatal hernia (including

Facility Only: $1,186 Inpatient only, not reimbursed for hospital

fundoplication), via laparotomy, except neonatal; without

outpatient or ASC

implantation of mesh or other prosthesis

Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; with implantation of mesh or other prosthesis

Facility Only: $1,299 Inpatient only, not reimbursed for hospital outpatient or ASC

Repair, paraesophageal hiatal hernia (including

Facility Only: $1,278 Inpatient only, not reimbursed for hospital

fundoplication), via thoracotomy, except neonatal; without

outpatient or ASC

implantation of mesh or other prosthesis

Repair, paraesophageal hiatal hernia (including fundoplication), via thoracotomy, except neonatal; with implantation of mesh or other prosthesis

Facility Only: $1,366 Inpatient only, not reimbursed for hospital outpatient or ASC

Repair, paraesophageal hiatal hernia, (including fundoplication), via thoracoabdominal incision, except neonatal; without implantation of mesh or other prosthesis Repair, paraesophageal hiatal hernia, (including fundoplication), via thoracoabdominal incision, except neonatal; with implantation of mesh or other prosthesis

Facility Only: $1,484 Inpatient only, not reimbursed for hospital outpatient or ASC

Facility: $1,582

Inpatient only, not reimbursed for hospital outpatient or ASC

3

CPT? CODE2

CODE DESCRIPTION

PHYSICIAN3

AMBULATORY

HOSPITAL

SURGICAL CENTER4 OUTPATIENT4

43210

43280 43325 43327 43328

47120 47122 47125 47130

38500 38510 38520 38525 38530 38542 38562 38564 38570 38571 38572

38700 38720 38724 38740

FUNDOPLICATION (EG, FOR GERD) Esophagogastroduodenoscopy, flexible, transoral; with Facility: $439 esophagogastric fundoplasty, partial or complete, includes duodenoscopy when performed

Laparoscopy, surgical, esophagogastric fundoplasty (eg, Facility: $1,113 Nissen, Toupet procedures)

Esophagogastric fundoplasty; with fundic patch (ThalNissen procedure) Esophagogastric fundoplasty partial or complete; laparotomy

Facility: $1,403 Facility: $845

Esophagogastric fundoplasty partial or complete; thoracotomy

Facility: $1,150

HEPATECTOMY (LIVER) Hepatectomy, resection of liver; partial lobectomy

Facility: $2,408

Hepatectomy, resection of liver; trisegmentectomy Hepatectomy, resection of liver; total left lobectomy Hepatectomy, resection of liver; total right lobectomy

Facility: $3,523 Facility: $3,167 Facility: $3,405

LYMPH NODE PROCEDURES Biopsy or excision of lymph node(s); open, superficial

Biopsy or excision of lymph node(s); open, deep cervical node(s) Biopsy or excision of lymph node(s); open, deep cervical node(s) with excision scalene fat pad

Biopsy or excision of lymph node(s); open, deep axillary node(s) Biopsy or excision of lymph node(s); open, internal mammary node(s) Dissection, deep jugular node(s) Limited lymphadenectomy for staging (separate procedure); pelvic and para-aortic

Facility: $263 Non-Facility: $351 Facility: $428 Non-Facility: $545 Facility: $478 Non-Facility: NA Facility: $453 Non-Facility: NA Facility Only: $580

Facility Only: $529 Facility Only: $724

$3,794

$8,908

$3,794

$8,908

Inpatient only, not reimbursed for hospital outpatient or ASC Inpatient only, not reimbursed for hospital outpatient or ASC

Inpatient only, not reimbursed for hospital outpatient or ASC

Inpatient only, not reimbursed for hospital outpatient or ASC

Inpatient only, not reimbursed for hospital outpatient or ASC Inpatient only, not reimbursed for hospital outpatient or ASC Inpatient only, not reimbursed for hospital outpatient or ASC

$1,176 $1,176 $1,176

$3,158 $3,158 $3,158

$1,176

$1,176 $2,306 N/A for ASC

$3,158

$3,158 $5,060 $8,908

Limited lymphadenectomy for staging (separate procedure); retroperitoneal (aortic and/or splenic)

Facility Only: $726 Inpatient only, not reimbursed for hospital outpatient or ASC

Laparoscopy, surgical; with retroperitoneal lymph node sampling (biopsy), single or multiple

Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy

Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling (biopsy), single or multiple

Suprahyoid lymphadenectomy

Facility Only: $527 $2,306 Facility Only: $676 $3,794 Facility Only: $930 $3,794

Facility Only: $817 $2,251

$5,060 $8,908 $8,908

$5,534

Cervical lymphadenectomy (complete)

Cervical lymphadenectomy (modified radical neck dissection) Axillary lymphadenectomy; superficial

Facility Only: $1,362 $2,788

$8,920

Facility Only: $1,471 Inpatient only, not reimbursed for

hospital outpatient or ASC

Facility Only: $907 $2,306

$5,060

4

CPT? CODE2 38746 38747

38760 38765

38770 38780

19300 19301 19302 19303 19305 19306 19307

48140 48145 48146 48150

CODE DESCRIPTION

PHYSICIAN3

AMBULATORY SURGICAL CENTER4

HOSPITAL OUTPATIENT4

Thoracic lymphadenectomy by thoracotomy,

Facility Only: $219 Inpatient only, not reimbursed for hospital

mediastinal and regional lymphadenectomy (List

outpatient or ASC

separately in addition to code for primary procedure)

Abdominal lymphadenectomy, regional, including celiac, Facility Only: $274 Inpatient only, not reimbursed for hospital

gastric, portal, peripancreatic, with or without para-aortic

outpatient or ASC

and vena caval nodes (List separately in addition to code

for primary procedure)

Inguinofemoral lymphadenectomy, superficial,

Facility Only: $861 $2,251

$5,534

including Cloquets node (separate procedure)

Inguinofemoral lymphadenectomy, superficial, in

Facility Only: $1,338 Inpatient only, not reimbursed for hospital

continuity with pelvic lymphadenectomy, including

outpatient or ASC

external iliac, hypogastric, and obturator nodes

(separate procedure)

Pelvic lymphadenectomy, including external iliac,

Facility Only: $821 Inpatient only, not reimbursed for hospital

hypogastric, and obturator nodes (separate

outpatient or ASC

procedure)

Retroperitoneal transabdominal lymphadenectomy,

Facility Only: $1,061 Inpatient only, not reimbursed for hospital

extensive, including pelvic, aortic, and renal nodes (separate

outpatient or ASC

procedure)

MASTECTOMY Mastectomy for gynecomastia

Facility: $440

$1,176

$3,158

Non-Facility: $599

Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy Mastectomy, simple, complete

Facility Only: $680 $1,176 Facility Only: $935 $2,251

Facility Only:$989 $2,251

$3,158 $5,534

$5,534

Mastectomy, radical, including pectoral muscles, axillary lymph nodes Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes (Urban type operation) Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle

Facility Only: $1,181 Inpatient only, not reimbursed for hospital outpatient or ASC

Facility Only: $1,258 Inpatient only, not reimbursed for hospital outpatient or ASC

Facility Only: $1,222 $2,251

$5,534

PANCREATECTOMY

Pancreatectomy, distal subtotal, with or without

Facility Only: $1,612 Inpatient only, not reimbursed for hospital

splenectomy; without pancreaticojejunostomy

outpatient or ASC

Pancreatectomy, distal subtotal, with or without splenectomy; with pancreaticojejunostomy

Facility Only: $1,688

Inpatient only, not reimbursed for hospital outpatient or ASC

Pancreatectomy, distal, near-total with preservation of duodenum (Child-type procedure)

Facility Only: $1,953 Inpatient only, not reimbursed for hospital outpatient or ASC

Pancreatectomy, proximal subtotal with total duodenectomy, partial gastrectomy,

Facility Only: $3,213 Inpatient only, not reimbursed for hospital outpatient or ASC

choledochoenterostomy and gastrojejunostomy (Whipple-

type procedure); with pancreatojejunostomy

5

CPT? CODE2

CODE DESCRIPTION

PHYSICIAN3

AMBULATORY

HOSPITAL

SURGICAL CENTER 4 OUTPATIENT4

48152

48153

48154

48155 38100 38101 38102 38120 S2900

Pancreatectomy, proximal subtotal with total

Facility Only:$2,989 Inpatient only, not reimbursed for hospital

duodenectomy, partial gastrectomy,

outpatient or ASC

choledochoenterostomy and gastrojejunostomy (Whipple-

type procedure); without pancreatojejunostomy

Pancreatectomy, proximal subtotal with near-total

Facility Only: $3,203 Inpatient only, not reimbursed for hospital

duodenectomy, choledochoenterostomy and

outpatient or ASC

duodenojejunostomy (pylorus-sparing, Whipple- type

procedure); with pancreatojejunostomy

Pancreatectomy, proximal subtotal with near-total

Facility Only: $3,002 Inpatient only, not reimbursed for hospital

duodenectomy, choledochoenterostomy and

outpatient or ASC

duodenojejunostomy (pylorus-sparing, Whipple- type

procedure); without pancreatojejunostomy

Pancreatectomy, total

Facility Only: $1,881 Inpatient only, not reimbursed for hospital

outpatient or ASC

SPLENECTOMY

Splenectomy; total (separate procedure)

Facility Only: $1,186 Inpatient only, not reimbursed for hospital

outpatient or ASC

Splenectomy; partial (separate procedure)

Facility Only: $1,202 Inpatient only, not reimbursed for hospital

outpatient or ASC

Splenectomy; total, en bloc for extensive disease, in

Facility Only: $268 Inpatient only, not reimbursed for hospital

conjunction with other procedure (List in addition tocode

outpatient or ASC

for primary procedure)

Laparoscopy, surgical, splenectomy

Facility Only: $1,088 $3,794

$8,908

ROBOTIC ASSISTANCE5

Surgical techniques requiring use of robotic surgical

HCPCS II S-codes cannot be reported to Medicare. They are used

system

only by non-Medicare payers, which cover and price them according

to their own requirements.

REFERENCES:

1.Centers for Medicare & Medicaid Services. Alpha-numeric HCPCS.

2.CPT copyright 2020 American Medical Association. All rights reserved. CPT? is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein

3.Centers for Medicare & Medicaid Services. Medicare Program; CY 2021 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Medicaid Promoting Interoperability Program Requirements for Eligible Professionals; Quality Payment Program; Coverage of Opioid Use Disorder Services Furnished by Opioid Treatment Programs; Medicare Enrollment of Opioid Treatment Programs; Electronic Prescribing for Controlled Substances for a Covered Part D Drug; Payment for Office/Outpatient Evaluation and Management Services; Hospital IQR Program; Establish New Code Categories; Medicare Diabetes Prevention Program (MDPP) Expanded Model Emergency Policy; Coding and Payment for Virtual Check-in Services Interim Final Rule Policy; Coding and Payment for Personal Protective Equipment (PPE) Interim Final Rule Policy; Regulatory Revisions in Response to the Public Health Emergency (PHE) for COVID-19; and Finalization of Certain Provisions from the March 31st, May 8th and September 2nd Interim Final Rules in Response to the PHE for COVID-19; Final Rule, Federal Register (85 Fed. Reg. No. 248 84472- 85377) 42 CFR Parts 400, 410, 414, 415, 423, 424, and 425.

4.Centers for Medicare & Medicaid Services. Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; New Categories for Hospital Outpatient Department Prior Authorization Process; Clinical Laboratory Fee Schedule: Laboratory Date of Service Policy; Overall Hospital Quality Star Rating Methodology; Physician-owned Hospitals; Notice of Closure of Two Teaching Hospitals and Opportunity To Apply for Available Slots, Radiation Oncology Model; and Reporting Requirements for Hospitals and Critical Access Hospitals (CAHs) to Report COVID-19 Therapeutic Inventory and Usage and to Report Acute Respiratory Illness During the Public Health Emergency (PHE) for Coronavirus Disease 2019 (COVID-19); Final Rule, Federal Register (85 Fed. Reg. No.249 85866-86305) 42 CFR Parts 410, 411, 412, 414, 419, 482, 485 and 512. Addendum B, AA, BB.

6

HOSPITAL INPATIENT PROCEDURE CODING

ICD-10-PCS procedure codes1 are used by hospitals to report surgeries and procedures performed in the inpatient setting.

ICD-10-PCS PROCEDURE CODE

PROCEDURE CODE DESCRIPTION

PARTIAL ADRENALECTOMY, PARTIAL EXCISION OF ADRENAL GLAND, EXCISION OF LESION OF ADRENAL GLAND

0GB20ZZ

Excision of left adrenal gland, open approach

0GB30ZZ

Excision of right adrenal gland, open approach

0GB40ZZ

Excision of bilateral adrenal glands, open approach

0GB24ZZ

Excision of left adrenal gland, percutaneous endoscopic approach

0GB34ZZ

Excision of right adrenal gland, percutaneous endoscopic approach

0GB44ZZ

Excision of bilateral adrenal glands, percutaneous endoscopic approach

TOTAL ADRENALECTOMY

0GT20ZZ

Resection of left adrenal gland, open approach

0GT30ZZ

Resection of right adrenal gland, open approach

0GT40ZZ

Resection of bilateral adrenal glands, open approach

0GT24ZZ

Resection of left adrenal gland, percutaneous endoscopic approach

0GT34ZZ

Resection of right adrenal gland, percutaneous endoscopic approach

0GT44ZZ

Resection of bilateral adrenal glands, percutaneous endoscopic approach

APPENDECTOMY

0DTJ0ZZ

Resection of appendix, open approach

0DTJ4ZZ

Resection of appendix, percutaneous endoscopic approach

CHOLECYSTECTOMY

0FT40ZZ

Resection of gallbladder, open approach

0FT44ZZ

Resection of gallbladder, percutaneous endoscopic approach

PARTIAL ESOPHAGECTOMY, PARTIAL EXCISION OF ESOPHAGUS, EXCISION OF LESION OF ESOPHAGUS

0DB10ZZ

Excision of upper esophagus, open approach

0DB20ZZ

Excision of middle esophagus, open approach

0DB30ZZ

Excision of lower esophagus, open approach

0DB40ZZ

Excision of esophagogastric junction, open approach

0DB50ZZ

Excision of esophagus, open approach

0DB14ZZ

Excision of upper esophagus, percutaneous endoscopic approach

0DB24ZZ

Excision of middle esophagus, percutaneous endoscopic approach

0DB34ZZ

Excision of lower esophagus, percutaneous endoscopic approach

0DB44ZZ

Excision of esophagogastric junction, percutaneous endoscopic approach

0DB54ZZ

Excision of esophagus, percutaneous endoscopic approach

TOTAL ESOPHAGECTOMY 0DT10ZZ

Resection of upper esophagus, open approach

0DT20ZZ

Resection of middle esophagus, open approach

0DT30ZZ

Resection of lower esophagus, open approach

0DT40ZZ

Resection of esophagogastric junction, open approach

0DT50ZZ

Resection of esophagus, open approach

0DT14ZZ

Resection of upper esophagus, percutaneous endoscopic approach

0DT24ZZ

Resection of middle esophagus, percutaneous endoscopic approach

7

ICD-10-PCS PROCEDURE CODE PROCEDURE CODE DESCRIPTION

0DT34ZZ

Resection of lower esophagus, percutaneous endoscopic approach

0DT44ZZ

Resection of esophagogastric junction, percutaneous endoscopic approach

0DT54ZZ

Resection of esophagus, percutaneous endoscopic approach

PARTIAL GASTRECTOMY, PARTIAL EXCISION OF STOMACH, EXCISION OF LESION OF STOMACH

0DB60ZZ

Excision of stomach, open approach

0DB64ZZ

Excision of stomach, percutaneous endoscopic approach

TOTAL GASTRECTOMY

0DT60ZZ

Resection of stomach, open approach

0DT64ZZ

Resection of stomach, percutaneous endoscopic approach

REPAIR OF DIAPHRAGMATIC HERNIA (HIATAL HERNIA)

Note that fundoplication for associated GERD is coded separately as below.

WITH IMPLANTATION OF MESH

Character 3 is the root operation. When mesh is used to affect the repair, the root operation is U-Supplement because U-Supplement is defined as putting on or in material, such as mesh, that physically reinforces a body part.2 The codes are then further differentiated by the type of mesh.

0BUR07Z

Supplement right diaphragm with autologous tissue substitute, open approach

0BUR0JZ

Supplement right diaphragm with synthetic substitute, open approach

0BUR0KZ

Supplement right diaphragm with nonautologous tissue substitute, open approach

0BUS07Z

Supplement left diaphragm with autologous tissue substitute, open approach

0BUS0JZ

Supplement left diaphragm with synthetic substitute, open approach

0BUS0KZ

Supplement left diaphragm with nonautologous tissue substitute, open approach

0BUR47Z 0BUR4JZ

Supplement right diaphragm with autologous tissue substitute, percutaneous endoscopic approach Supplement right diaphragm with synthetic substitute, percutaneous endoscopic approach

0BUR4KZ

0BUS47Z 0BUS4JZ

Supplement right diaphragm with nonautologous tissue substitute, percutaneous endoscopic approach Supplement left diaphragm with autologous tissue substitute, percutaneous endoscopic approach

Supplement left diaphragm with synthetic substitute, percutaneous endoscopic approach

0BUS4KZ

Supplement left diaphragm with nonautologous tissue substitute, percutaneous endoscopic approach

WITHOUT IMPLANTATION OF MESH

Character 3 is the root operation. When mesh is not used to affect the repair, the root operation is Q-Repair. This root operation is a default.

0BQR0ZZ

Repair right diaphragm, open approach

0BQRS0ZZ

Repair left diaphragm, open approach

0BQR4ZZ

Repair right diaphragm, percutaneous endoscopic approach

0BQRS4ZZ

Repair left diaphragm, percutaneous endoscopic approach

FUNDOPLICATION (EG, FOR GERD)

Character 3 is the root operation. For fundoplication, the root operation is V-Restriction because V-Restriction is defined as partially closing a lumen.2

0DV40ZZ

Restriction of esophagogastric junction, open approach

0DV44ZZ

Restriction of esophagogastric junction, percutaneous endoscopic approach

0DV48ZZ

Restriction of esophagogastric junction, via natural or artificial opening endoscopic

8

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