May 19, 2022 Question: I had to take a patient back to the operating room 6 weeks after breast reduction to excise a small dehiscence and close the wound. Can I bill for this? Answer: Yes, you may bill for the service and you’ll need to use modifier 78 (return to the OR for a...
May 5, 2022 Question: One of our spine surgeons has asked me to help with an upcoming case. The patient is obese and has had multiple prior spine procedures. The spine surgeon would like me to close using bilateral paraspinal muscle flaps. How do I code the procedure and will I even get paid? Answer:...
April 21, 2022 Question: We are having a debate on whether to use a mastectomy code or breast reduction code for “top” female-to-male procedures. What’s your advice? Answer: Unfortunately, we do not have a specific CPT code(s) for these procedures as the existing codes were not written with these procedures in mind. Our advice is...
April 7, 2022 Question: I was told that if I recommend surgery then I can automatically bill 99205 or 99215. This seems too good to be true. Please advise. Answer: You’re right – you’ve been given inaccurate information. Remember, office visit codes (99202 – 99205, 99212 – 99215) require meeting or exceeding two of the...
March 24, 2022 Question: We billed 19371 (capsulectomy) with a breast reconstruction implant exchange (19342 – larger to smaller). We were denied 19371. Should we have used modifier 59 on 19371 to get paid? Answer: This Medicare National Correct Coding Initiative (NCCI) edit is a dilemma. CPT implies that you are allowed to use both...
March 10, 2022 Question: A patient has a partial mastectomy by a general surgeon. After the surgery, a plastic surgeon comes in to close due to possible reconstruction. The plastic surgeon ends up only doing a layered closure. A layered closure is inclusive the in the partial mastectomy (19301) but is the plastic surgeon still...
February 24, 2022 Question: We precertified and billed a nasal fracture CPT code. The payor requested the operative note which we sent. The payor then denied the procedure and said we didn’t bill the right code. I don’t understand. Answer: After reading the operative note you sent, I understand the denial. The Indications said the...
February 10, 2022 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, the original surgery was canceled and is now under consideration for rescheduling due to the pandemic and the patient needs...
January 27, 2022 Question: I did an inpatient consultation and coded 99253 (non-Medicare). I did not need to follow the patient so I signed off. They asked me to re-consult a week later. What is the code for a re-consult? Answer: There are no specific E/M codes for an inpatient re-consultation. You’ll use the subsequent...
December 30, 2021 Question: A few years ago I was at your plastic surgery coding workshop in Chicago – you were great, Kim! I remember discussing the adjacent tissue transfer or rearrangement codes and you said we need a size dimension to code for CPT 14040 or 14041 or any of the ATT codes. Do...
