June 10, 2021 Question: If I do both a breast reduction, 19318, and liposuction of the breast, 15877, do I bill both codes? Answer: No – the liposuction is not separately reported. This service is included in the breast reduction code assuming breast tissue is surgically removed to support 19318. *This response is based on...
May 27, 2021 Question: In doing DIEP flap reconstruction, oftentimes I take out an incidental intra-mammary lymph node. Can I code 38530 for this? Answer: No, removal of incidental lymph node(s) encountered in the operative field are included in the DIEP flap CPT code. *This response is based on the best information available as of...
May 13, 2021 Question: My doctor performed 19342 (exchange of larger implant to smaller implant), 15771 (grafting of autologous fat) and 15839 (excision of excessive skin). We were denied for 15839 and I have sent a corrected claim with updated diagnosis codes for 15839 but the claim was again denied. Can you help please? Answer:...
April 29, 2021 Question: My physician is utilizing an open laceration on the patients chin for open reduction of a mandibular symphysis fracture. He wants to also charge for complex laceration repair for that laceration. Is this billable or is it part of the ORIF code? Answer: If the fracture is repaired through the laceration...
April 15, 2021 Question: Under the new E/M coding revisions for office visits, should we document time AND medical decision making for every visit? Answer: According to advice from the AMA (3/24/21 webinar), you should only document one or the other to prevent potential audit confusion and risk. Document time if billing by time OR...
April 1, 2021 Question: I use two ADMs on each breast during a tissue expander reconstruction. Can I bill +15777 x 4 units? Answer: No, you’ll use the code +15777 once for each breast Question: I’m confused on whether to bill +15777 twice (once on each side) or with modifier 50. Please advise. Answer: Good...
March 18, 2021 Question: I just realized CPT 19366 was deleted in 2021. Now what code do I use for an oncoplastic reconstruction? Answer: You’re right – CPT 19366 (Breast reconstruction with other technique) was deleted this year. You will code for whatever procedure you end up doing such as an adjacent tissue transfer (e.g.,...
March 4, 2021 Question: We do a lot of hand surgery and have an x-ray machine in the office. This has made me confused about how to count the data for the neurosurgeon’s E/M code. Please help. Answer: Good question and let’s simplify things. The AMA specifically states there should be “no incentive”, related to...
February 18, 2021 Question: Would bilateral large breasts, on a patient that we are recommending breast reduction, count as 2 problems in the new E/M guidelines for office visits? Answer: No because these two problems will have the same concurrent treatment (breast reduction). Therefore, it counts as 1 problem. *This response is based on the...
February 4, 2021 Question: I’m confused about the Data component for the new office visit guidelines. What do I get credit for when a patient brings in her mammogram report? Answer: Good question. Assuming you (or your same specialty partner) did not order or bill for the mammogram, you would receive Category 1 Data credit...
