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Old Codes Die Hard

Paul S. Koch, M.D.

Amanda and Sue are my wizened office coders and I am quite fond of them. They don't knock on my door very often, so when they do I am always happy to usher them in, brew up a few steaming cups of espresso, draw up a chair, and have a listen.

Each has done coding for years, so when they are occasionally stumped looking up a CPT code you might jump to the conclusion that it's going to be a doozy. It might, indeed, be one with a capital D, but that's a conclusion you shouldn't bet the farm on. You should hedge the bet with another on the adequacy of the coding lists.

Recently I mentioned that I was intrigued by the resurgence of lamellar reconstructive corneal surgery. Some learned circles are suggesting that the end of penetrating keratoplasty is approaching because we are learning to transplant only the parts of the cornea that we need. Endothelial transplants that can treat corneal edema and stromal augmentation that could reinforce keratoconus are only two of the potential applications of lamellar reconstructive corneal surgery.

"Okay boss, let's find a code for that." Lamellar keratoplasty is listed, but that's the manual dissection code from 30 years ago. It doesn't come close to describing modern lamellar tissue harvesting and replacement. But look, keratomileusis has a code, and so do keratophakia, epikeratoplasty and radial keratotomy. Has anyone done one of these operations within the past 10 years? "I bet those codes are getting a lot of use," I say sarcastically, and they laugh loudly to humor me.

We flip over to the glaucoma page. I perform viscocannalostomy and believe the future direction of glaucoma surgery points toward Schlemm's Canal surgery. I see codes for full thickness sclerotomy and thermocauterization (Scheie Procedure). Does anyone still do those operations? Look over here! There's still a code for iridencleisis, an operation abandoned during the Ford administration, or was it the Nixon? Why is it still there?

As we leaf through the book, I tell them stories about this code or that, ones we'll never use again, but that, unlike the old soldier, will never fade away.

Codes Should Be Current

The codes must be reviewed, updated and contemporized. Procedures no longer performed should be gracefully retired and others that are more relevant should slip into those slots. It simply isn't right that surgeons have to dance around unused listings while not having access to codes that better reflect the work we do.