July 22, 2021 Question: What happened to the skin biopsy codes? I submitted a claim for 11101 (skin biopsy) and +11101 (additional lesion) and it was denied for “invalid code.” Answer: CPT deleted CPT codes 11100 and +11101, effective 1/1/19, and replaced them with the follow six new codes: 11102 Tangential biopsy of skin (eg,...
July 8, 2021 Question: We are hiring a scribe for the doctor because it will help improve his documentation. Is there anything we need to know about how to document this? Answer: Yes, absolutely. This situation should be clearly delineated so a third party reviewer can identify the provider who performed the service, and the...
June 24, 2021 Question: Our physicians utilize residents during surgery but we have a discrepancy in what is considered a “Qualified Resident”. Some physicians consider a resident qualified to assist day 1 of their residency rotation, while others consider only 4th and 5th year residents as qualified to assist. Can you guide us to documentation...
June 10, 2021 Question: Can you code a PTH (blood draw), during a parathyroidectomy? Answer: Monitoring the Parathyroid hormone (PTH), including the blood draw, is included in the parathyroidectomy and not separately reported. *This response is based on the best information available as of 6/10/21.
May 27, 2021 Question: I was told I cannot bill for FAST exams done in the ED for a trauma patient, if permanent recordings of the images are not retained. Is that correct? Answer: Yes. All diagnostic ultrasounds require 1) a separate interruption of the structures visualized and the findings in each and 2) a...
May 13, 2021 Question: What is REBOA and how is it coded? Answer: REBOA is used in trauma for patients that are rapidly bleeding from injuries to the chest, abdomen or pelvis. A flexible catheter is placed in the femoral artery, advanced to the aorta and a balloon is inflated at its tip. This stops...
April 29, 2021 Question: The surgeon accidentally nicked a vessel not involved in the bypass being performed, can he bill for repair of vessel since he had to repair it? Answer: Iatrogenic, intraoperative complications that are repaired at the same operative session are not separately reported. Since the vessel laceration was an iatrogenic injury, inadvertently...
April 15, 2021 Question: A vascular surgeon is requested to come to the OR to repair a blood vessel that my surgeon inadvertently nicked during a colectomy. Is he a co-surgeon or assistant on the case? Answer: Neither. The vascular surgeon will report his work, repair of vessel, and you will report yours. *This response...
April 1, 2021 Question: Our general surgeon performed a radical mastectomy and is now performing a port placement, at a separate session, for the patient. What modifier should we use on the port placement since both procedures are related to her diagnosis of breast cancer? Answer: Although the diagnosis for each procedure is breast cancer,...
March 18, 2021 Question: Do some insurance carriers want modifier 58 and others want 78? What is the difference in these modifiers? Answer: Modifier 58 is used on a subsequent surgery when a planned (or staged) related procedure is performed within the global period of the first surgery. If possible, but not required, the surgeon...
