The General Surgery Coding Coach 2012 Archives

 

Question: 

Our surgeon performed a biopsy of colon polyp on 3/13/12. During the global period, 2 weeks later, the patient was taken back to the OR for another biopsy. We reported 45380 for the first procedure and 45380-76 for the second procedure. We received a denial from Medicare stating this was an invalid modifier. What modifier should we have used?

 

Answer:

First, CPT code 45380 does not have any global days. When the patient was returned to the OR 2 weeks later for the same procedure, CPT code 45380 (assuming this is correct CPT code) should have been reported without any modifiers Second, most Medicare payors do not recognize modifier 76 on surgical CPT codes during the global period. Medicare recognizes modifier 76 on surgical CPT codes on the same day as the original surgical procedure, but does not recognize on surgical CPT codes beginning the day after surgery.

 

Question: 

Is the intraoperative neural integrity monitoring considered part of the total thyroidectomy (60240) or is there a separate code for it? I am looking at CPT code 95865 to report this procedure for our surgeon?

 

Answer:

Intraoperative nerve monitoring (IOM) is not separately reportable by the surgeon as it is considered an integral part of the procedure. IOM is reportable by a second physician who is not participating in the case such as a neurologist or physical medicine physician.

Question: 

Our practice employs five general surgeons, a colorectal surgeon and a vascular surgeon. We were reading with interest the 2012 CPT changes and were wondering if this revision affects how we report new and established patient visits. They are all “general” surgeons, but the colorectal and vascular surgeons are  credentialed  with Medicare as colorectal and vascular surgeons respectively.

 

Answer:

Great question and one that was “clarified” in 2012 but for your purposes really changed nothing.  Medicare has recognized vascular surgery and colorectal surgery as different specialties within general surgery for some time. General Surgery is specialty code “20”; Vascular Surgery is specialty code “77”; Colorectal Surgery is specialty code “28”.   This allows you to bill a new patient the first time the patient is seen by a physician of their respective specialty.

What this means, and is clarified in 2012, is that the first time the patient is seen by the general surgeon, a new patient visit can be reported, and likewise for the vascular and colorectal surgeon. This, of course, assumes that the patient has not received any professional services from a physician, same group, same specialty/subspecialty within the past three years. If the patient was seen by the vascular surgeon in consultation in the hospital and then follows up in the office, it is an established patient, as the patient has received professional services. If the general surgeon on call sees the patient in the hospital and transfers care to the vascular surgeon and the first visit to the vascular surgeon is in the office, the vascular surgeon reports a 9920x.  While they are in the same group, the vascular surgeon is a different “specialty” as recognized by Medicare.

Question:
I am so excited!  I have recently passed my certification as a coding auditor and have taken on a new job doing nothing but audits.  I am reviewing an office note and have a question related to a statement in the note.  The surgeon documented “Neck is supple, no JVD or lymphadenopathy.”  I am not sure where to give credit for these statements in the Review of Systems.  I know I can give credit for skin and lymphatic but not sure if I am capturing everything.  Can you assist me?

 

Question:
Patient had a malignant lesion removed on the right neck. The wound size required the surgeon to harvest a split thickness skin graft. We know the lesion has a ten day global and the skin graft has a 90 day global period. Our question is: Since there are 2 separate global days, if the patient comes in for a recheck of the lesion after the ten day global period, can the surgeon bill for an E&M for the lesion re-check.

 

Question:
Our surgeon was called to the OR to perform and intraoperative consultation. How do we
report this service?

 

Question:
Our tumor physician performed a large resection and was left with what he perceived to be “at risk tissue” that required the use of biologic grafts to reconstruction the internal tissue and provide reinforcement. He was able to close the wound with a complex repair after reconstructing the deeper tissue and providing internal structure protection. Can I use 15777 for this purpose?

 

Question:
I am new to general surgery coding this past December and have a surgeon who dictates his procedures as “VATS” Procedure. After doing some research, I understand this is an acronym for video assisted thoracic surgery. But, I can’t find specific CPT codes, so am wondering do I use an unlisted code?