Coding Resources
GENERAL SURGERY
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Documenting Codes In the Procedure Report
January 9, 2020 Question: I’ve been dictating CPT and ICD-10-CM codes in my procedure note so that my coder knows…
Coding for ICG Imaging
December 19, 2019 Question: Can you give guidance on CPT 15860 as it pertains to colorectal surgery? My surgeons have…
Skin Biopsy Codes
December 5, 2019 Question: What happened to the skin biopsy codes? I submitted a claim for 11101 (skin biopsy) and…
Use of a Scribe
November 14, 2019 Question: We are hiring a scribe for the doctor because it will help improve his documentation. Is…
How do you define “No Qualified Resident Available”?
October 31, 2019 Question: Our physicians utilize residents during surgery but we have a discrepancy in what is considered a…
PTH Blood Draw with a Parathyroidectomy
October 17, 2019 Question: Can you code a PTH (blood draw, during a parathyroidectomy? Answer: Monitoring the Parathyroid hormone (PTH),…
Coding for FAST Exams
October 3, 2019 Question: I was told I cannot bill for FAST exams done in the ED for a trauma…
Coding for Percutaneous Tracheostomy
September 19, 2019 Question: What code is used for percutaneous tracheostomy? Answer: Code 31600 is reported for “percutaneous” tracheostomy. This…
Coding for REBOA
September 5, 2019 Question: What is REBOA and how is it coded? Answer: REBOA is used in trauma for patients…
Code +15777 for placement of a non-biologic implant. Is this the correct code?
August 22, 2019 Question: I placed a non-biological implant for abdominal soft tissue reinforcement. Can this be coded as +15777?…
Reporting a Cholecystectomy and an Umbilical Hernia at the Same Operative Session
August 8, 2019 Question: If a patient undergoes an open cholecystectomy and has a reducible umbilical hernia repaired during the…
Reporting a Cholecystectomy with a Cholangiogram
July 25, 2019 Question: If a cholangiogram was performed by the surgeon during a cholecystectomy, but the radiologist interprets it,…
Billing for an iatrogenic injury, not my patient. (Stage 2)
July 11, 2019 Question: My surgeon was called to the OR by an OB-GYN who accidentally lacerated the bowel during…
Billing for an iatrogenic injury, not my patient. (Stage 1)
June 20, 2019 Question: My surgeon was called to the OR by an OB-GYN who accidently lacerated the the small…
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…
E-Consults?
May 23, 2019 Question: One of my colleagues told me that she was doing e-consults with other physicians for Medicare…
Modifier 78 vs 59
May 9, 2019 Question: What modifier do we use if a patient is returned to the OR the same day…
Global Period for Debridement
April 25, 2019 Question: I thought the global period of debridement of muscle or bone was 10 days. Is that…
Debridement Coding
April 11, 2019 Question: If 10 sq. cm subcutaneous tissue is debrided from the right leg and 20 sq. cm…
Coding for Trauma Resuscitation
March 28, 2019 Question: How do we bill for a trauma resuscitation? Are there codes for hanging fluids and packed…
What does “separate procedure “mean in a CPT code description?
March 14, 2019 Question: What does “separate procedure” mean when it follows a CPT code description? Answer: Per CPT :…
Laparoscopic Pyloroplasty
February 28, 2019 Question: How is a laparoscopic pyloroplasty reported? Can I use code 43800, Pyloroplasty? Answer: No, codes without…
Peritoneal Catheter Placement
February 14, 2019 Question: I placed the peritoneal catheter for a neurosurgeon placing a V-P shunt. Do I code 49419,…
Co Surgeon or assistant?
January 31, 2019 Question: A vascular surgeon is requested to come to the OR to repair a blood vessel that…
Choosing a Modifier with a Colostomy Revision
January 17, 2019 Question: What modifier is used to report a colostomy revision during the global period of the stoma…
Coding Mesh Placement in Hernia Repairs
December 13, 2018 Question: If mesh is placed for a laparoscopic hernia repair can an unlisted code be reported for…
Billing an Endoscope Post Colectomy
November 29, 2018 Question: I routinely do a sigmoidoscopy (or other endoscopic procedure) to assess the integrity of the anastomosis…
Thrombolysis Through a Chest Tube (Correction of Transposed Code Numbers)
November 15, 2018 Question: How is installation of tPA into a chest tube coded? Answer: Report this with the following…
Modifier 59 and 51. Do we need both?
November 1, 2018 Question: Should we append both 59 and 51 when a code is bundled and is also a…
Trauma Laparotomy
October 18, 2018 Question: Is there a specific CPT code for trauma laparotomy? Answer: No. if an exploratory laparotomy is…
Articles
Does My Documentation Tell the Story in Critical Care?
Does My Documentation Tell the Story in Critical Care? SCCM Critical Connections – August 2019 by Deborah Grider The initial and…
Is Your Practice Not Getting Paid?
AAOSNow – July 2017 by Michael R. Marks, MD, MBA, and Cheryl Toth, MBA Coding May Not Be the Reason…
Liability Management 101
Liability Management 101 – August 2016 by Michael R. Marks, MD, MBA Why Malpractice Insurance Is Not Enough Today’s orthopaedic practices…
OIG Says "No Bonus Points" for Having a Compliance Plan
AAOS Now – July 2016 by Cheryl Toth, MBA New announcements and guidance push providers toward an active program If your…
The Revenue Engine that Could “Think You Can” by Refining the Revenue Cycle with the Right People, Processes, and Tools
Greenbranch – May/June 2013 Kim Pollock, RN, MBA, CPC Many physicians continue to wrestle with an economy-in-recovery and declining reimbursements. In…
8 Things Your Medical Billing Service Should Be Doing
Physicians Practice – 2016 by Karen Zupko What has your billing service done for you lately? A good vendor does more than just…
Is Your Bariatric Practice Ready for Retail?
Mystery Shopping Results Indicate a Need for Improvement – April 2016 by Karen Zupko and Samantha Lappe After the news of a…
The Impact of ICD-10 Implementation
by Kyle M. Lee Survey finds a smooth road so far On Oct. 1, 2015, the 10th revision of the…
Surviving in an ICD-10 World
by Deborah Grider, CPC, COC, CPC-I, CPC-P, CEMC, CPMA, CCS-P, CDIP Certified AHIMA Clinical Documentation Improvement Practitioner AHIMA-Approved ICD-10-CM/PCS Trainer…
Practice Transition Planning: When Is the Right Time?
The American Journal of Orthopedics – December 2015 by Karen Zupko, BSJ If you are a solo orthopedic surgeon or…
The Only Safe SMS Texting Is No SMS Texting
Greenbranch – Nov/Dec 2015 by Cheryl Toth, MBA, and Michael J. Sacopulos, JD Many physicians and practice staff use short messaging…
Reduce Medical Practice Embezzlement Risk by Implementing Cash Controls
Physicians Practice – September 2013 by Karen Zupko and Cheryl Toth, MBA Several years ago, we visited a practice in…
21st-Century Patient Collections: Implement a Point-of-Service Collections Program Now
The American Journal of Orthopedics – May 2015 by Cheryl Toth, MBA An 8-surgeon group in the Southeast had a…
Seven Surefire Ways to Start a Nonphysician Practitioner Off Right
The Journal of Medical Practice Management – January/February 2015 by Cheryl Toth, MBA With the proper planning and preparation, nonphysician…
The Patient Relations and Service Recovery Guide: A Colorful Approach to Handling Upset and Angry Patients
The American Journal of Orthopedics – January 2015 by Jennifer A. O’Brien, MSOD Tearful breakdowns and loud outbursts—they happen with…
Patient Portal in Your Orthopedic Surgery Practice: You Can So Do This
The American Journal of Orthopedics – September 2014 by Jennifer A. O’Brien, MSOD On initial consideration, the patient portal portion…
Banking: Shop and Compare
Journal of Medical Practice Management – May/June 2014 by Jennifer A. O’Brien, MSOD, and Sherry DeJarnette, CPA There are many reasons to…
Avoid Billing Service Nightmares: Issues to consider before partnering with independent and hospital-based billing services
AAOS Now – April 2014 by Jennifer A. O’Brien, MSOD In addition to the compliance and security issues highlighted in…
What To Expect from the Orthopaedic Surgery Practice Manager
AAOS Now – April 2014 by Jennifer A. O’Brien, MSOD When a physician gives an order to a nurse, technician,…
Avoid Billing Service Nightmares: Use Business Rigor to Reduce Your Risk: Part I
AAOS Now – February 2014 by Cheryl L. Toth, MBA Recently, an orthopaedic surgeon remarked that he was thinking about…
Are Your Business Associate Agreements HIPAA (Omnibus) Compliant?
Plastic Surgery News Connection – 2013 by Karen Zupko If you’ve been “too busy” to update your Business Associate Agreements…
The Employment Agreement: What Every Doctor (Junior and Senior) Needs to Know, Parts 1, 2, and 3
Journal of Practice Management – May/June 2000; July/August 2000; September/October 2000 by James G. Stuart J.D. This is the first…
