July 11, 2019 Question: When are diagnostic angiograms and an intervention (angioplasty, stent, etc) both billable? Answer: Diagnostic angiograms are separately billable during an intervention if no adequate, prior adequate angiogram exists. Code diagnostic angiograms only if: no previous angiogram is available, the prior angiogram is not adequate to diagnose the disease, or the patient’s...
June 20, 2019 Question: What is TCAR and how is it coded? Answer: TCAR stands for Transcarotid Artery Revascularization. It is essentially an open carotid stent procedure. A small incision is made just above the collar bone to expose the common carotid artery. A sheath is placed directly into the carotid artery and connected to...
June 6, 2019 Question: I’ve been dictating CPT codes in the operative note so that my coder knows what to bill. Recently, we had an insurance company call us out because the codes we billed were not the same as the codes in the operative note. Now I am not sure what to do. What...
May 23, 2019 Question: The surgeon accidentally nicked a vessel not involved in the bypass being performed, can he bill for repair of vessel since he had to repair it? Answer: Iatrogenic, intraoperative complications that are repaired at the same operative session are not separately reported. Since the vessel laceration was an iatrogenic injury, inadvertently...
May 9, 2019 Question: The vascular surgeon is called to the OR to repair a blood vessel that was inadvertently lacerated during a colectomy. I she a co-surgeon? Answer: No. The vascular surgeon will report her work with a repair vessel code (35221 if repaired directly). The other surgeon will report the work that he/she...
April 11, 2019 E-Consults? 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...
March 28, 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...
March 14, 2019 Question: I thought the global period of debridement of muscle or bone was 10 days. Is that true? Answer: The debridement codes were revised in 2011 and the global period for all codes (11042-11047) was revised to 0 days. *This response is based on the best information available as of 3/14/19.
February 28, 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...
February 14, 2019 Question: What does “separate procedure” mean when it follows a CPT code description? Answer: Per CPT : Some of the procedures or services listed in the CPT codebook that are commonly carried out as an integral component of a total service or procedure have been identified by the inclusion of the term...
