12016Sep

Billing for Bravo Placement

September 1, 2016 Question: How do I bill for the Bravo placement? I’m coding an EGD with 43235 and the Bravo code, 91035 but getting denied. Answer: Great question and one that came up at a recent ACS coding course! First, if endoscopy is performed to evaluate the underlying problem, this is coded as a…

162016Aug

Is It Co-Surgery or Not?

August 18, 2016 Question: I was called into the OR by a urologist who was doing a nephrectomy for a malignancy. He noted a lesion on the spleen I was called in to remove the spleen. Is this co-surgery or assistant surgery? Answer: Thank you for your question. In the American College of Surgeons (ACS)…

42016Aug

Reimbursement: Co-surgery

August 4, 2016 Question: What is the reimbursement for co-surgery? Is it different for the primary and co-surgeon? Answer: For Medicare, co-surgery requires two different specialties performing separate parts of a single CPT code. Private payers may have different policies regarding the specialties involved. For both surgeons, a 62 modifier is appended to the appropriate…

202016Jul

Reimbursement: Assistant Surgeon

July 21, 2016 Question: What is the reimbursement for an assistant surgeon using modifier 80? Is the payment different for the primary and the assistant? Answer: Assistant surgeon is described as one surgeon, of the same or a different specialty, providing assistance during a surgical procedure or CPT code. Modifier 80 (modifier 82 for an…

62016Jul

Signing NPP Notes

July 7, 2016 Question: Do I have to sign each of my NP’s notes that are reported incident to? Answer: The guidelines for reviewing and signing NPP documentation are set by each state in its scope of practice regulations. Each practice must research those requirements individually. But as an employer, you are responsible for the…

92016Jun

New vs. Established Patient

June 9, 2016 Question: If I see a new patient and during that visit I identify the need for surgery the same day, can I append a Modifier 57 to the E/M service and get paid? Answer: You determine during the evaluation that the patient would need surgery the same or next day for a…

262016May

Sliding Hiatal Hernia

May 26, 2016 Question: How do I code for an open repair of a sliding hiatal hernia? Answer: Per CPT, report code 43327 for an open repair of a sliding hiatal hernia via a laparotomy approach and 43328 for the repair via a thoracotomy approach. For more detailed information about hiatal hernias; laparoscopic approaches, coding…

122016May

Using Modifier 57

May 12, 2016 Question: I saw a patient on a Friday and scheduled surgery for that Monday. Do I need a 57 modifier on the E/M I did on Friday? Answer: No. The 57 modifier is required on an E/M code that is the decision for surgery visit if it occurs the day of or…

132016Apr

Source for a Consult

April 14, 2016 Question: What is an appropriate “source” for a consult? I asked at a recent workshop and the instructor did not have an answer. Answer: CPT guidelines state that a consultation must be requested by a physician or ”other appropriate source”. CPT defines other appropriate source as a physician assistant, nurse practitioner, doctor…

312016Mar

Minor vs. Major Procedure

March 31, 2016 Question: What is the difference between a minor and major procedure? Answer: A minor procedure is defined as one with a zero or 10 day global period. For example, debridement has a zero day global period, and excision of a benign skin lesion has a 10 day global period. A major procedure…

172016Mar

Initial Evaluation

March 17, 2016 Question: Can a surgeon always be paid for an initial evaluation before a major surgery, or is that included as part of the global package? Answer: A surgeon may always be paid for an initial evaluation before a surgery with 90 global days. If that visit takes place the day or the…

32016Mar

On-Q Pain Pump Coding

March 3, 2016 Question: My doctor repaired an inguinal hernia and also placed On-Q pain pumps. Can these be billed with an unlisted code? Answer: Good question! Any pain management provided by the operating surgeon, including placing On-Q pain pump, is part of the global package and not separately reported. *This response is based on…

22016Feb

Separate Procedure. What does it mean?

February 2, 2016 Question: I noticed that some codes in general surgery have “separate procedure” at the end of the code, for example: 44005, open enterolysis (lysis of adhesions). What does that mean? Answer: The “separate procedure” designation means that this procedure is not reported if it is performed at the same time or through…

32015Dec

Coding Incomplete Colonoscopies

December 3, 2015 Question: Which code would be appropriate to report 45330, Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) or 45378, Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure), if the physician is unable to advance the colonoscope to the…

82014Aug

Submucosal Injections with Colonoscopy

August 8, 2014 Question: Our colorectal surgeon injected “India ink” at the site of a polyp removal. The surgeon is telling me this is a separately reportable procedure and I am saying it is not because you can only report one procedure per polyp. Who is correct? Answer: In this case, the surgeon is correct….

242014Jul

Complex Closure

July 24, 2014 Question: Our surgeon performed a complex repair to close the wound following a mastectomy she performed. We were wondering if this is separately reportable. Answer: Thanks for your inquiry. Your question is actually a common one we are asked, so it’s a great time to make it a Coding Coach question. The…

262014Jun

Unilateral Thyroidectomy or Completion?

June 26, 2014 Question: Our surgeon performed a partial thyroidectomy and during the global period the pathology returned positive. The surgeon took the patient back to the operating room for a completion thyroidectomy during the global period. Do I report the return to the OR as a unilateral thyroid or completion? Answer: The correct code…

12014May

Modifier 78 Global Period Payment

May 1, 2014 Question: If a Medicare patient returns to the operating room during the post-op period and we bill the claim with a modifier 78 is the claim payment reduced? Answer: Yes, Medicare will apply a payment reduction to the surgical CPT code for the unplanned return to the OR. While a payment reduction…

172014Apr

Excision of a Skin Lesion

April 17, 2014 Question: When coding for excision of a skin lesion (114xx, 116xx), do I use the size on the pathology report to determine the correct CPT code? Answer: The most accurate measurement, according to CPT, is when the lesion has not yet been excised and is still on the patient. The specimen reduces…

32014Apr

Adrenelectomy for Tumor During a Nephrectomy

April 3, 2014 Question: I performed a laparoscopic adrenelectomy for tumor with a urologist at the same time that she performed a nephrectomy. Do I report 60650, laparoscopic adrenelectomy? Or am I an assist on her case? Answer: Neither! You acted as co- surgeon on a single CPT code 50545, laparoscopic radical nephrectomy (includes removal…

292014Mar

Intra-operative Duplex Studies. Are They Billable?

March 29, 2014 Question: After a fem-pop bypass or a carotid endarterectomy, I always do an intra-operative duplex to evaluate vessel patency. Can I report my supervision and interpretation of that duplex study? Answer: No, assessing success of an open procedure, i.e., evaluating vessel patency, whether the procedure is a bypass, endarterectomy, etc, is part…

62014Mar

Intraoperative Monitoring

March 6, 2014 Question: When performing a thyroidectomy or parathyroidectomy, and a physician’s assistant is assisting, can the PA bill for the nerve monitoring codes, 95867, 95868, +95940? Answer: No, neither the surgeon or an assistant surgeon or even a co-surgeon may bill for intraoperative nerve monitoring.

202014Feb

Gynecomastia

February 20, 2014 Question: Our staff were having difficulty obtaining precertification for a male patient with gynecomastia. When I submitted my surgical codes for the day, I gave the staff CPT code 19300 Mastectomy for Gynecomastia. My staff said I could not report this code, but had to report 19301 for a partial mastectomy. I…

62014Feb

Can We Bill CPT Code 76098?

February 6, 2014 Question: The surgeon always documents examination of the specimen during her breast biopsy procedures and wants to report CPT code 76098. Is this correct? Answer: No, CPT code 76098 is not separately reportable when reporting the breast biopsy codes 19081-19086.

232014Jan

Partial Mastectomy and Lymphadenectomy

January 23, 2014 Question: We are discussing a recent case the surgeon submitted for coding review. She performed a “partial mastectomy with axillary lymphadenectomy.” It appears we have two choices. We could report the partial mastectomy (19301) and the axillary lymphadenectomy code (38745) or there is a code 19302, Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy,…

262013Dec

Sentinel Node Biopsy With Lymphadenectomy

December 26, 2013 Question: The surgeon documented that she performed a partial mastectomy, sentinel node mapping, sentinel node biopsy and a complete lymphadenectomy. Our question is directed at the sentinel node biopsy only as we are receiving denials for this procedure. We are reporting CPT code 38525 with 19302 and are receiving a denial as…

122013Dec

Flat Rate Pay for Clinic Visits

December 12, 2013 Question: A private practice client recently received an email news alert with the following headline (“Medicare to pay flat rate for clinic visits”) and asked if this applied to the physicians in their practice when they were on call at the hospital. Answer: In late summer, CMS announced that hospital payments for…

262013Nov

Consult In ER

November 26, 2013 Question: Our surgeon was called to the Emergency Room to see a patient in consultation. The patient was discharged from the Emergency Room. Can you tell us how to report this? Answer: The correct category of CPT code will be dependent on payor rules. According to the 2013 AMA CPT rules, the…

142013Nov

Preventive Screening Services

November 14, 2013 Question: A patient (non Medicare) presented for a screening colonoscopy. During the procedure the surgeon performed a polypectomy with hot forceps. I know I append modifier 33 for screening colonscopy but do I also append to the CPT code when a procedure is performed (45384) and not just a screening procedure? Does…

312013Oct

New or Established Patient Visit?

October 31, 2013 Question: Two of our surgeons (breast) are hospital employed and work within the Breast Center. Sometimes we see patients as direct consultations from the primary care physician and report consultations as appropriate. Our question is do we bill a consultation or a new patient visit when the patient is sent to the…

192013Sep

Colonoscopy With Biopsy and AV Malformation

September 19, 2013 Question: I submitted a claim to a payor for a colonoscopy with biopsy of a polyp in the transverse colon and control of bleeding at the site of an AV malformation (original planned surgery). I submitted the following codes and received a denial (45382 and 45380) from Medicare. I resubmitted to Medicare…

52013Sep

Separate Procedure Codes

September 5, 2013 Question: Our surgeons work in a productivity employed model. I want to make sure I am capturing all the possible procedures to ensure correct coding and capturing the surgeons work. Recently the surgeon performed an exploratory laparoscopy CPT code 49320 and a laparoscopic cholecystectomy, CPT code 47562. CPT code 49320 has a…

222013Aug

Debridement of Burn Wound

August 22, 2013 Question: Our trauma surgeon documented that he performed a subcutaneous debridement of a 15 sq. cm third degree burn to the left foot. We are unsure if we should report 11042 or a burn code? Answer: Thanks for your inquiry. The appropriate CPT code range will be found in the burn section,…

252013Jul

Image Guidance with CVC Insertion

July 25, 2013 Question: Our surgeon recently attended a coding course presented by Mary LeGrand for the College of Surgeons. Upon returning to our office, the surgeon informed us that we can report a CPT code for image guidance when he places a central line. He showed me the codes in the book. I just…

112013Jul

Thyroidectomy and Parathryoidectomy Same Day

July 11, 2013 Question: Our surgeon recently had a surgical procedure where the patient had a thyroid goiter and a parathyroid adenoma. Can I report both a thyroidectomy CPT code and the parathyroidectomy CPT code or are they bundled together? Answer: The answer to your question really lies in your scenario. You note that the…

272013Jun

Colonoscopy and EGD On the Same Day

June 27, 2013 Question: We are in a multi-specialty group and recently hired a gastroenterologist. Our colorectal surgeon wants to know if she performs a colonoscopy on the same day that the gastroenterologist performs an EGD, for example, will both services be paid? Answer: Yes, we would expect both physicians to be paid and at…

22013May

Other Qualified Health Care Professionals

May 2, 2013 Question: I see CPT added the statement, “other qualified health care professionals”: throughout the 2013 CPT manual. In our general surgery practice we employ physician assistants, registered nurses and medical assistants. Does this term now apply to all of these personnel meaning I can bill for their services if the code includes…

182013Apr

Add-On Codes

April 18, 2013 Question: I am new to general surgery coding. I see that the placement of mesh for an incisional or ventral hernia has a “+” sign and a statement to “list in addition to the primary procedure.” What is an add-on code? Answer: An Add-on code describes additional intra-operative work typically related to…

212013Mar

Intra-Operative Consultations

March 21, 2013 Question: I read with interest your coding coach question on Intra Op Consults. We love going to the coding courses Mary LeGrand presents for th ACS. I think I understand why the intra-op consultation was not reportable when the surgeon was called in just to repair the enterotomy. Recently our surgeon was…

72013Mar

Laparoscopic Procedure Converted to Open

March 7, 2013 Question: A patient presents for a laparoscopic colectomy for sigmoid diverticulitis. The surgeon starts the procedure laparoscopically and has to convert to an open due to extensive lysis of adhesions and scarring and converts to an open colectomy. I am thinking she can report the laparoscopic and open but I am not…

212013Feb

Intraoperative Consults: Is This Consultation Separately Reportable Or Not?

February 21, 2013 Question: Our General Surgeon was called into an OB/GYN case to repair a small incidental enterotomy that occurred during an OB/GYN procedure. Can our surgeon report an intraoperative consultation service in addition to the surgical procedure to repair the enterotomy? Answer: Thanks for your inquiry. In the scenario described the intraoperative consultation…

102013Jan

Pain Catheter Placement

January 10, 2013 Question: Our surgeons have been instructed that they may report CPT codes 62361 and 62362 for the insertion of pain pumps when performing laparoscopic gastric band procedures. We have been trying to do some research and cannot figure out if these are acceptable codes are not. Can you advise? Answer: Thanks for…

272012Dec

Lower Extremity Revascularization Codes

December 27, 2012 Question: The guidelines for the new lower extremity revascularization codes (angioplasty, stent, atherectomy) state that they include all radiological supervision and interpretation directly related to the intervention. Does that include diagnostic studies? Answer: No, diagnostic studies are separately reportable as long as all coding rules for reporting diagnostic studies have been followed….

132012Dec

Diagnostic Angiograms

December 13, 2012 Question: I heard at a seminar that diagnostic angiograms performed at the same operative session as a stent or angioplasty can never be billed. Is that true? Answer: No that is not exactly true. According to CPT, diagnostic angiograms performed at the time of an interventional procedure may be separately reported if:…

292012Nov

Iliac Atherectomy

November 29, 2012 Question: If a common iliac atherectomy is performed and a stent is placed in the same vessel can both be billed? What about the catheterization and radiological supervision and interpretation? Answer: As of 2011, supra-inguinal atherectomies (which include all iliac vessels) are reported with Category III codes. These codes specifically state that…

152012Nov

Medicare Auditors – Is My Practice At Risk?

November 15, 2012 Question: We’re hearing a lot about ZPICs and their focus on vascular practices. What is a ZPIC? Answer: ZPIC stands for Zone Program Integrity Contractors. ZPICs are private companies under contract to Medicare to identify areas of program fraud and abuse and to facilitate payment recoupment of misspent funds to Medicare. The…

12012Nov

Medical Necessity Audit

November 1, 2012 Question: Our Medicare carrier has asked for several patient records from our vein center. They say they are conducting a medical necessity audit. What does that mean? Answer: Most Medicare carriers have a written coverage policy, referred to as a local carrier determination or LCD, that delineates the signs, symptoms, ultrasound findings…

182012Oct

Conversion of Laparoscopic Procedure to Open

October 18, 2012 Question: The surgeon in our practice performed a laparoscopic exploratory laparotomy that turned into a laparoscopic omentectomy. Do I bill the unlisted laparoscopy procedure 49329 or Omentectomy 49255 with modifier 52 reduced services? Answer: Thanks for questioning whether you should report the appropriate unlisted code or the open omentectomy code with a…

62012Sep

Is There A CPT Code for a Wound Vac?

September 6, 2012 Question: Our surgeon placed a “wound vac” on an open leg wound. The surgeon stated it was separately reportable but I cannot find a CPT code. Can you help? Answer: Yes, there are CPT codes for “wound vacs” and perhaps one of the reasons you cannot find them, is that the “wound…

92012Aug

Carotid Angioplasty Without Stenting

August 9, 2012 Question: I know that carotid stenting with embolic protection is coded as 37215. But how would you code for a carotid angioplasty without stenting? Answer: A percutaneous carotid angioplasty is reported as 35475, transluminal angioplasty, percutaneous; brachiocephalic trunk or branches, each vessel. The associated radiological supervision and interpretation code, 75964 should also…

262012Jul

I&D In the Office During Global Period

July 26, 2012 Question: Our surgeon saw a patient in the office for a routine post-op check during the global period of a thyroidectomy. During the visit, the surgeon notes that the patient has some neck fullness and performs an incision and drainage in the office. I have the correct CPT code, but I am…

122012Jul

What Global Period to Follow

July 12, 2012 Question: Patient had a malignant lesion removed on the right neck. The wound size required the surgeon to harvest a split thickness skin graft. We know the lesion has a ten day global and the skin graft has a 90 day global period. Our question is: Since there are 2 separate global…

282012Jun

Biologic Grafts Coding

June 28, 2012 Question: Our tumor physician performed a large resection and was left with what he perceived to be “at risk tissue” that required the use of biologic grafts to reconstruction the internal tissue and provide reinforcement. He was able to close the wound with a complex repair after reconstructing the deeper tissue and…

142012Jun

Sentinel Node Biopsy

June 14, 2012 Question: Does the surgeon have to document that the sentinel node was removed via a separate incision from the mastectomy in order to report CPT code 38525 in addition to the mastectomy? Answer: Thanks for your inquiry. There are no requirements for a separate incision to report a sentinel lymph node biopsy…

312012May

CPT and Diagnosis Codes for a Skin Lesion

May 31, 2012 Question: A patient was sent to us by another provider who had a biopsy proven pathology report showing a basal cell carcinoma. We removed additional margins and the pathology report came back benign for us. We are confused about whether we should report the CPT and diagnosis codes for a malignant or…

172012May

Coding Renal Angiography: 2012 Changes

May 17, 2012 Question: The renal angiography codes are no longer in the 2012 CPT book. What happened? Answer: Per CPT 2012, the renal angiography codes have been bundled with the associated renal catheterization codes. Prior to 2012, renal angiography was reported as 75722 for unilateral and 75724 for bilateral. Catheterization codes were separately reported….

32012May

45380 and Modifier 76

May 2, 2012 Question: Our surgeon performed a biopsy of colon polyp on 3/13/12. During the global period, 2 weeks later, the patient was taken back to the OR for another biopsy. We reported 45380 for the first procedure and 45380-76 for the second procedure. We received a denial from Medicare stating this was an…

292012Mar

New Patient vs Established Patient

May 29, 2012 Question: Our practice employs five general surgeons, a colorectal surgeon and a vascular surgeon. We were reading with interest the 2012 CPT changes and were wondering if this revision affects how we report new and established patient visits. They are all “general” surgeons, but the colorectal and vascular surgeons are credentialed with…

152012Mar

Review of System or Exam Element

March 15, 2012 Question: I am so excited! I have recently passed my certification as a coding auditor and have taken on a new job doing nothing but audits. I am reviewing an office note and have a question related to a statement in the note. The surgeon documented “Neck is supple, no JVD or…

12012Mar

What Global Period to Follow

March 1, 2012 Question: Patient had a malignant lesion removed on the right neck. The wound size required the surgeon to harvest a split thickness skin graft. We know the lesion has a ten day global and the skin graft has a 90 day global period. Our question is: Since there are 2 separate global…

162012Feb

Intraoperative Consultations

February 16, 2012 Question: Our surgeon was called to the OR to perform and intraoperative consultation. How do we report this service? Answer: The service will be dependent on the payor. Report 9925X Inpatient Consultation if the payor still recognizes consultation services. Report 9922x or 9923x to Medicare based on the documentation.

262012Jan

15777: Implantation of Biologic Implant

January 26, 2012 Question: Our tumor physician performed a large resection and was left with what he perceived to be “at risk tissue” that required the use of biologic grafts to reconstruction the internal tissue and provide reinforcement. He was able to close the wound with a complex repair after reconstructing the deeper tissue and…

122012Jan

VATS Procedure

January 12, 2012 Question: I am new to general surgery coding this past December and have a surgeon who dictates his procedures as “VATS” Procedure. After doing some research, I understand this is an acronym for video assisted thoracic surgery. But, I can’t find specific CPT codes, so am wondering do I use an unlisted…