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...
March 4, 2021 Question: A major blood vessel was accidentally nicked while a general surgeon was performing a complex case. A vascular surgeon was called in to repair the blood vessel. Since they are different specialties, can the vascular surgeon bill for the repair, even though she is in the same group as the general...
February 18, 2021 Question: My surgeon was called into a laparoscopic operation that was already underway, to perform extensive lysis of adhesions. Does he need to use a modifier 52 because the patient was already “opened”, or can we just bill for 44180 Laparoscopic lysis of adhesions? Answer: You would bill for 44180 without a...
February 4, 2021 Question: The surgeon performed an open colectomy and found a tear in the mesentery close to the incision, 44850 Suture of mesentery is listed as a “separate procedure”, does that mean we can bill for it separately in addition to the colectomy? Answer: No, codes designated as a “separate procedure” are intended...
January 21, 2021 Question: In the new guidelines, how does Time affect billing for a teaching physician’s E/M service when the resident spends a great deal of time with the patient? Answer: Good question! Only the time of teaching physician would “count” in the scenario you describe. The new guidelines say that the time of...
December 17, 2020 Question: I’ve heard that all you need to document for family history is the word “none”, and that would count as documenting. Is this enough? Answer: No. Documenting “none” is saying that the patient does not have a family history, and this would not be accurate as we all have a family...
December 3, 2020 Question: Our surgeon insists on billing for 49002 reopening of a recent laparotomy and a 44005 lysis of adhesions, since the case is complicated because the laparotomy was only 60 days ago. Can he bill for both in any circumstance? Answer: Although this was a reopening of a recent laparotomy, lysis of...
November 12, 2020 Question: My coder just told me about the new guidelines for 2021 office visit codes. She said I no longer have to document a History. This doesn’t seem right to me. Answer: You are wise to ask because that’s not exactly true. It is correct that the History will no longer be...
October 29, 2020 Question: While performing an enterostomy closure (44626) a tear in the small bowel was made during extensive lysis of adhesions. Can this be billed as a 44120, since it required surgical repair and couldn’t be avoided due to the severity of the lysis? Answer: Although the tear was from friable (fragile) tissue...
