Category: Coding Coach

Burn Debridements
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Burn Debridements

October 15, 2020 Question: Our patient had full thickness burn of foot and has been having serial debridements to the bone 25x17cm. Patient returned to operating room for another debridement down to the bone then reconstruction of foot with a muscle flap. For the debridements prior to flap closure, is it appropriate to code 11044...

Bjork Flap Tracheostomy
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Bjork Flap Tracheostomy

October 15, 2020 Question: What would the correct CPT code be for a tracheostomy performed using a Bjork flap? I see some people stating it should be 31610. However, a Bjork flap is technically not a skin flap. I thought CPT 31610 was more for when a permanent stoma is created. Answer: CPT 31600 is...

Billing Separately for Diagnostic Angiograms
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Billing Separately for Diagnostic Angiograms

October 15, 2020 Question: Our surgeon performed an aortogram with run-off to bilateral lower extremities. He then performed interventions in the left SFA and the left peroneal arteries. My question is regarding documentation of the diagnostic imaging Can he also bill for a diagnostic angiogram? What about catheterization to get there? Answer: Diagnostic imaging during...

Subacromial Decompression (29826)
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Subacromial Decompression (29826)

October 15, 2020 Question: Our surgeon frequently documents in the procedure title that an arthroscopic subacromial decompression was performed.  We are billing 29826 and are receiving denials from one particular payor stating that the documentation does not support the service.  I am looking at the operative notes associated with these denials and see that in...

MOHS with an E/M Service
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MOHS with an E/M Service

October 15, 2020 Question: A Medicare patient came in last week and my doctor did a biopsy on the chest and it came back malignant and meets the Medicare criteria for MOHS surgery. The patient came in today and he performed a level 3 E/M visit and did MOHS surgery in 2 stages. I am...

Billing for “Icy Green” Dye
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Billing for “Icy Green” Dye

October 15, 2020 Question: The surgeon did a robotic/laparoscopic cholecystectomy and cholangiogram with icy green and firefly identification of biliary anatomy. He billed a 47563.  Can he can bill separately for the icy green and firefly dye? Answer: Billing for indocyanine (ICG) or Firefly TM fluorescence is bundled into 47563 laparoscopic cholecystectomy with cholangiogram and is not separately billable. *This...

Are Pre-Op Visits Billable?
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Are Pre-Op Visits Billable?

October 1, 2020 Question: For patients that are having surgery that day, I’ve been doing pre-op visits that morning (coming in earlier), and not doing a preop visit in clinic the week before surgery. Can I bill a follow up visit for the meeting/note (H&P) that occurs the morning of surgery? Answer: No – a...

Modifier 78: Global Period Impact
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Modifier 78: Global Period Impact

October 1, 2020 Question: We have a patient who had knee surgery and required a return to the operating suite for treatment of a complication during the global period. We will bill the second surgery with a modifier 78. My supervisor is saying the aftercare needs to be extended another 90 days because the surgeon...

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Coding Coaches