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...
July 8, 2021 Question: We have a patient that needs a major revision rhinoplasty requiring cadaver cartilage. There is no remaining local cartilage that can be utilized in this case and my surgeon has opted to use cadaver instead of rib cartilage. I know local grafts are not separately reportable, but is there a way...
June 24, 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...
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:...
