Question:
New CPT Codes for DS in 2005

I'm posting this to further respond to a recent question here -- this is from one of the Rabkins' patients, who I believe is in the insurance biz -- I have no idea what it means in real life, but if you are submitting for surgery in the coming weeks, you might want to make sure your surgeon uses this new CPT code as well: The CPT 2005 code book has the following Category I code assignment on page 178: 43845 Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenalileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption. (biliopancreatic diversion with duodenal switch) I could find no entry describing a lap DS explicitly, although the RNYGB was assigned one for lap. The code becomes effective on January 1, 2005; insurers are given information regarding changes and additions to the code book a few weeks before it gets published, so insurers already know the DS has its very own code now. I just got my book today, so you can figure they've known about it since the first week in October at least. ALSO: The code newly assigned for the duodenal switch (43845) is NOT a category II or III code (the not ready for prime time categories); there was some concern last February that the editorial board would assign the DS its own single code but put it in the II or III categories. As category II and III are used to track the soundness of procedures or gather more datat on procedures, I infer the assignment of a category I code indicates the DS procedure has been adequately studied to be put into general use. The new code will become effective January 1, 2005. The insurance companies were informed of new codes several weeks ago in order to give them time to be ready to implement the new data on the first of the new year. (As a cynical soul, I grumble that the extra time is given so they can formulate new reasons for not covering a procedure -- grrrrrrrrr.) The stance of the AMA on giving codes to procedures is that the code assignment signifies "Inclusion of a descriptor and its associated five-digit number in the CPT book is based on whether the procedure is consistent with contemporary medical practice and is performed by many practitioners in clinical practice in multiple locations." Code assignment, of course, does not equal AMA endorsement. The standard RNYGB (code 43846) was given a new code for when it is performed laparoscopically -- 43644 -- but I could not find a lap code specifically for the DS.    — [Deactivated Member] (posted on October 26, 2004)

October 27, 2004
Diana- as a coder I assure you the codes HAVE to be given out in advance for computer updates and such. Its a nightmare way beyond trying to find reasons for approval/denial (codes arent used only for insurance but were originally developed for statistical purposes). I have some info here that I got on all the new CPT codes but I filed it in the "to do later" bin since I'm dealing right now with all the new ICD-9 codes that went in effect 10/1. Cat II and III codes are simply codes for emerging technologies and for a few other reasons that are used for a limited amount of time, and either turned into a Cat I code (given new #) or eliminated. If you can't find a lap code for the DS, then an unlisted laparoscopy code will continued to be used...I'll check those out for you later. Also another FYI, the codes do go in effect 1/1 as you stated. In previous years there was a "grace period" for a few months that was given to allow facilities/ offices/insurance companies to start using the new codes...but that has been eliminated, and they MUST start using the new codes this year on 1/1. Thanks for the info...hopefully offices are up to speed w/ the changes. Shannon
   — M. Me