Procedure Question

Question:

I am doing a lot of Goldie Locks breast reconstruction after mastectomy where I create a lower pole pedicle dermal flap and use it for reconstruction. From what I can tell this is billed as an ATR at 14XXX. Is this the best code?

Answer:

There is not a good code for this service. The 14xxx code is probably the best but be sure to document the primary defect dimension (in sq cm), the lumpectomy defect, as well as any secondary defect dimension (the defect you created with your flap design) also in sq cm. Adding these defect dimensions together supports the 14xxx code.

*This response is based on the best information available as of 2/15/24.

Procedure Question

Question:

When do we use 1500X versus 160XX?

Answer:

Dressing changes and burn “debridement” are reported using the 160xx codes. Burn “excision,” in preparation for reconstruction with allograft or skin grafting, is reported using the 1500x codes. Be sure to use the words “debridement” vs “excision” to support the correct CPT codes.

*This response is based on the best information available as of 2/1/24.

Procedure Question

Question:

Often, we will take a burn patient to the OR with large sloughing skin and debride and apply allograft. Does this qualify as 1500X with 1527X or is this a 160XX burn debridement code with the skin sub codes?

Answer:

We expect to see documentation that the burn “excised,” not “debrided,” when allograft is applied. In the scenario where burn excision with allograft placement occur, the 1500x (excision) and 1527x (allograft) codes are used.

The 160xx codes are used for dressing changes and/or “debridement.”

Procedure Question

Question:

Steven Johnson syndrome. We see a lot of this. For these, we generally provide some sedation at bedside and use a norsen blade (basically a sharp straight edge) to debride off all the epidermal blistering and expose the dermis. We use CPT 97597 and 97598. Is this accurate?

Answer:

Yes, debridement of the epidermis and/or dermis is reported using 97597 and +97598.

You may separately report a code(s) for moderate sedation services (99152/+99153 for patients 5 years or older) if you are the physician supervising an independent trained observer (e.g., registered nurse). This is also true for any other CPT code where moderate sedation is provided under your supervision by an independent trained observer. The drug name, dosage, route, amount of time, etc. must be documented to support the moderate sedation service codes.

Procedure Question

Question:

When we take the patient to the OR to debride a wound or burn using Versajet what is the best CPT code to report? If we use a knife or curette or scissor to debride is that coded differently that a versajet?

Answer:

The depth of the wound determines the CPT code for debridement. The tool – Versajet, knife, curette or scissors – should be documented in the note to indicate how the debridement was performed.

The 1104x codes are used when the debridement is performed on a wound when the plan is healing by secondary intention. These codes are typically used for conditions such as ulcers, injuries, infections, and other wounds.

Burn dressing changes and/or debridement is reported using the 160xx codes, not the 1104x codes.

Time

Question:

Our physician is coding by time; he thinks this is the best for him. Frequently with a new patient he will also do an injection. He documents his total time for the day but does not document the amount of time performing a minor procedure (billable). There is no documentation of the time spent preparing for or performing the minor procedure. May we still report a service based on time?

Answer:

CPT states “Time” may be selected based on the total amount of time spent on the date of encounter, excluding time spent for services that are defined by a separately reportable CPT code. This means that the total time must exclude the amount of time spent related to the minor procedure. If not documented, KZA recommends asking the physician to amend the note if possible (attesting that the time is accurate to the best of their knowledge) or reporting the service based on MDM.