November 14, 2019 Question: What is the definition of simple vs complicated for the I&D codes 10060 versus 10061? Answer: While CPT doesn’t define the difference between “simple” and “complicated”, it is the accepted practice that a simple I&D 10060 is just that. An incision (not just a puncture) is performed, and the abscess is...
October 31, 2019 Question: If I see a new patient in consultation for a suspicious skin lesion and release them to their primary care provider and they come back to see my partner for eczema one year later on their own, can she report the encounter as a new patient visit? We are the same...
October 17, 2019 Question: CPT question for anatomy: When coding complex repairs CPT 13100-13102 for complex repair of trunk. What body area is included in the “Trunk”. For simple and intermediate repairs the trunk is included with the scalp, extremities, neck, axillae and trunk. Answer: You can determine the answer by looking at the code...
October 3, 2019 Question: Does this code description require a scalpel? If you do a punch excision – margins are clear. Can that be billed as excision ? Does excision require a scalpel? A patient got a bill and she is a nurse and claims it should be a punch biopsy. Answer: The excision codes...
September 19, 2019 Question: Do you have to await the pathology report in order to assign the diagnosis of benign or malignant for a lesion; when reporting destruction codes 17000-17111 or any lesion removal codes? Answer: There are multiple answers to your question depending on which piece is addressed. I will try to address them...
September 5, 2019 Question: Our physicians have instructed us to bill under a physician’s NPI number for all Advanced Practitioners (PA’s and NPs) for all patients for Medicare as we follow incident-to billing. We have been submitting claims for all new and established patient visits regardless of whether there is a physician in the office....
August 22, 2019 Question: I’ve been dictating CPT and ICD-10-CM codes in my procedure note so that my coder knows what to bill. Recently, we had an insurance company call us out because the codes we billed were not the same as the codes in the procedure note. Now I am not sure what to do. What is...
August 8, 2019 Question: My physician performed Mohs surgery on a patient with a basal cell carcinoma on his cheek. He took the first stage with 6 tissue blocks, but does cancer is still evident in the margins based on the mappings. A second stage is removed with 4 tissue blocks. The second stage shows...
July 25, 2019 Question: I saw a patient for an excision of a squamous cell carcinoma on his chest. The size is 4.2 cm diameter. I know I report 11606 for the lesion excision but I also did an intermediate repair with a layered closure and the side is 6.5cm. Can I bill for the...
July 11, 2019 Question: Can we perform Mohs surgery without a pathology report? Answer: If you review CMS and other payor policies they all require a recent pathology report usually no more than 3 months old confirming the malignancy prior to performing Mohs surgery. *This response is based on the best information available as of...
