May 5, 2022 Question: We did an abdominal fat pad biopsy for primary cutaneous Amyloidosis. Would 49180 or 11104 be the appropriate code for this? Answer: 49180 is for a core sample within or behind the abdominal cavity. If the core biopsy is documented down to the subcutaneous fat pad only, this is coded as...
Category: CC-General Surgery
Coding a Hand Assisted Laparoscopy
April 21, 2022 Question: The surgeon described the procedure as a ‘hand assisted laparoscopy”. He brought part of the bowel outside of the body for evaluation. Does this convert the procedure to open? Answer: Mobilizing the bowel outside the body (extracorporeally) during a laparoscopic procedure does not convert the procedure to open, it is still...
2021 EM Guidelines: Only for Medicare?
April 7, 2022 Question: I work with a surgeon and we see just a few Medicare patients. The surgeon believes the revised 2021 E/M guidelines will not impact our office practice because of our low Medicare volume. Is this correct? Answer: This is not correct and is a common misconception. The revised documentation requirements come...
Hartmann or Partial Colectomy
March 24, 2022 Question: My surgeon performed all the components of a Hartmann procedure 44143 but did not create a colostomy. Can we use 44143 with a -52 modifier? Answer: The correct code for this procedure would be 44140. Code 44140 is the base code for 44143 with the only difference being a skin level...
Billing for a Wound Vac
March 10, 2022 Question: Can you bill for a wound vac on a surgical incision if the patient has a history of incision infections to help prevent this? Answer: The AMA published clarification on wound vac billing in the October 2021 CPT Assistant. Negative pressure wound therapy (97605-97606) is considered billable for both open and...
Using Modifier -22 for Adhesiolysis
February 24, 2022 Question: My provider indicated that it took her an additional 80 minutes during a surgery to perform adhesiolysis. Is documentation of the time sufficient? Answer: Although time (specific minutes) should always be indicated in the operative note, the provider must also give the reason why the lysis took longer (what complicated this...
Billing E/M Visits During the Global Period
February 10, 2022 Question: Can I bill different diagnosis codes for conditions/problems when seeing a patient in the hospital after surgery, but during the stay of a major surgery? Answer: It depends. You cannot bill for related issues or known complications that arise from the surgery, but you can bill for unrelated conditions/problems with proper...
Coding a Diverting Ileostomy with a Low Anterior Resection/Low Pelvic Anastomosis Partial Colectomy
January 27, 2022 Question: Instead of a colostomy as described in the laparoscopic CPT codes 44208 or the open code, 44146, my doctor does a diverting ileostomy. We have been billing the primary codes 44145 or 44207 and adding the ileostomy code, 44187 if laparoscopic or 44310 if open. Is that correct? Answer: Partial colectomy...
Intraoperative ICG Dye Angiography
December 30, 2021 Question: Can we bill the 92242 for the indocyanine green injection intraoperatively, for example to assess perfusion after a colectomy or other abdominal procedure? Can we bill for the injection using 15860? Answer: No, this service is included in primary surgery and not separately reported. *This response is based on the best...
Billing Additional Pre-op Visit
December 16, 2021 Question: Since we have to bring the patients back in for COVID testing and H&P for Joint Commission, can we bill for this visit even though it’s another pre-op visit? Answer: Yes, since the original surgery was canceled and is now under consideration for rescheduling due to the pandemic and needs to...