Category: General Surgery

Billing for an iatrogenic injury, my patient.
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Billing for an iatrogenic injury, my patient.

June 6, 2019 Question: The surgeon reported an intestinal perforation caused by a trocar during a laparoscopic cholecystectomy due to extensive adhesions.  He completed the cholecystectomy and also did a suture repair of one perforation of the small intestine. How is this reported? Answer: Iatrogenic, intraoperative complications that are repaired at the same operative session...

E-Consults?
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E-Consults?

May 23, 2019 Question: One of my colleagues told me that she was doing e-consults with other physicians for Medicare and getting paid.  Is this a billable service? Answer: Yes!  Medicare has added CPT codes 99446-99452 for interprofessional/ telephone/internet/electronic health record (EHR) consultations to the fee schedule, so they are now payable services.  These are...

Modifier 78 vs 59
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Modifier 78 vs 59

May 9, 2019 Question: What modifier do we use if a patient is returned to the OR the same day as the original surgery for post-op hemorrhage? Isn’t it 78 for this complication? Answer: Modifier 78 is a global period modifier and the global period begins on post-op day one. So it is not appropriate...

Debridement Coding
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Debridement Coding

April 11, 2019 Question: If 10 sq. cm subcutaneous tissue is debrided from the right leg and 20 sq. cm is debrided from the left leg, is it coded as 11042 and 11042-59 or 11042 RT and 11042 LT? Answer: If debridement is performed at the same depth of tissue (all subcutaneous tissue) it is...

Coding for Trauma Resuscitation
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Coding for Trauma Resuscitation

March 28, 2019 Question: How do we bill for a trauma resuscitation?  Are there codes for hanging fluids and packed cells? Can we use the CPR code 92950? Answer: There is no specific code for a trauma resuscitation or for administering fluids or blood products. The CPR code is specifically for providing cardiopulmonary resuscitation; chest...

Laparoscopic Pyloroplasty
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Laparoscopic Pyloroplasty

February 28, 2019 Question: How is a laparoscopic pyloroplasty reported? Can I use code 43800, Pyloroplasty? Answer: No, codes without the term laparoscopic in their description are intended as open codes and 43800 is an open code. There is no laparoscopic code for pyloroplasty so an unlisted code 43659 unlisted laparoscopic procedure, stomach, must be...

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