December 2, 2021 Question: One of our physicians is scheduling a nasal wall reconstruction with Latera®. He is wanting to use code 30465 (repair nasal vestibular stenosis). I know there is a code for Latera which is 30468 and I feel we should use this code. Please give me your opinion. Answer: CPT 30468 was...
November 11, 2021 Question: My doctor removed a tissue expander and placed a permanent implant. He made some minor adjustments so we billed 19342. The payor asked for the operative note so we sent it. Then we got a denial. I’m trying to figure out why 19342 would be denied. Answer: Good question and this...
October 28, 2021 Question: What is the code for an open septoplasty? I’m doing extracorporeal work removing the septum and reinserting it. It’s more difficult than a regular intranasal septoplasty, 30520. Answer: There is not a separate code for an open septoplasty – 30520 is all we’ve got. You could append modifier 22 (increased procedural...
October 14, 2021 Question: If a patient has one stable chronic illness and one acute uncomplicated illness without systemic symptoms, can we “up” the level of Problems Addressed to Moderate? Answer: No, sorry, unfortunately it doesn’t work that way. The problems are no additive or cumulative. One stable chronic illness and one acute uncomplicated illness...
September 30, 2021 Question: We did a debridement and repair of a wound dehiscence on a breast reconstruction patient. The denial said we did not have the right diagnosis code. We used S21.029A. What diagnosis code should we have used? Answer: S21.0029A is for traumatic laceration with foreign body of unspecified breast, initial encounter. The...
September 16, 2021 Question: We billed 15260 (full thickness graft, ear) and 13132 (complex repair, ear) and were not paid for the complex repair. Can you help us with an appeal? Answer: Suturing the full thickness graft into place is not separately coded with a complex repair or any other code. Affixing the full thickness...
September 2, 2021 Question: I heard that a medical assistant who enters the patient’s medications into the electronic health record must be certified. Is this true? Answer: Actually, Medicare requires the MA to be certified to perform order entry. They do not have to be certified to enter patient information such as vital signs or...
August 19, 2021 Question: We received a denial for 19357-50 (tissue expander reconstruction) and +15777 x 2 units. The denial reason was “the diagnosis code and CPT code combination is inappropriate”. We used a diagnosis of C50.911 (Malignant neoplasm of unspecified site of right female breast). What diagnosis code(s) should we have used? Answer: For...
August 5, 2021 Question: We are having trouble getting paid for the capsulotomy (19370) when billed with the revision code (19380) on the same side. Can you help? Answer: Sure! If all you’re doing is a capsulotomy for capsular contracture then you would bill only 19370. If you’re doing a capsulotomy with other procedures such...
July 22, 2021 Question: We did a septoplasty and repair of nasal vestibular stenosis with spreader grafts using septal cartilage. We billed these codes: 30465, 30520 and 20912. Medicare does not bundle any of these codes. So why did we not get paid on 20912? Should we have used modifier 59 or XS on 20912...
