292016Sep

Capsulectomy and Revision of Breast Reconstruction

September 29, 2016 Question: My doctor did a partial capsulectomy to revise the inframammary fold as well as fat grafting to some defects on a reconstructed breast. Additionally, he revised the scar and took off some excess lateral breast tissue. We submitted the following codes: 19380, 19371-59, 20926-59, and 15839-59. We only got paid on…

152016Sep

Reimbursement: Assistant Surgeon

September 15, 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 assistant…

12016Sep

Reimbursement: Co-Surgery

September 1, 2016 Question: What is the reimbursement for co-surgery using modifier 62? 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. For both surgeons, modifier 62 is appended to the appropriate CPT code(s). Medicare multiples the allowable by 125%…

162016Aug

Surgical Modifiers: How Do They Impact Reimbursement?

August 18, 2016 Question: What reimbursement should we expect when using the global period modifiers 58, 79 and 78? Answer: Surgical modifiers are used to indicate that a subsequent procedure was performed during the global period of a prior surgery. Modifiers tell the payer the rationale for allowing payment for this subsequent procedure. The modifiers…

42016Aug

Medicare X Modifiers: Use or Not Use?

August 4, 2016 Question: What’s new with the X modifiers established by Medicare? Should we be using them now? Answer: As of today, Medicare has yet to finalize a formal policy for the use of the -X{EPSU} modifiers as a replacement for modifier 59. The -X{EPSU} modifiers are shown below but have not yet been…

202016Jul

Source for a Consult

July 21, 2016 Question: What is an appropriate “source” for a consult? I asked at a recent workshop (not a KZA workshop!) and the instructors did not have an answer. Answer: The guidelines for a consultation (inpatient or outpatient) must be requested by a physician, or qualified non-physician practitioner. Guidelines are not clear regarding individuals…

62016Jul

New Patient Visit and Modifier 57

July 7, 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…

232016Jun

Signing NPP Notes

June 23, 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 care…

262016May

Three Layer Closure = Complex Repair?

May 26, 2016 Question: Is a 3-layer closure after a malignant skin lesion removal considered a complex repair code (131xx)? Answer: No. Actually, CPT says a “Complex repair includes the repair of wounds requiring more than layered closure, viz., scar revision, debridement (e.g., traumatic lacerations or avulsions), extensive undermining, stents or retention sutures.” The emphasis…

122016May

Transitional Care Management Codes

May 12, 2016 Question: We’ve been using the transitional care management codes, 99495-99496, for post-op discharge care (e.g., writing prescriptions, dictating the discharge summary) while the patient is in the hospital after surgery for breast reconstruction or flap reconstruction procedures. Medicare has been denying the codes. Should we appeal these denials? Answer: No, don’t appeal…

262016Apr

Excision of Scar

April 28, 2016 Question: Patient comes in for what they are calling scar revision and the note states that “standing cutaneous excess of the left abdominal scar” was sharply excised. We are billing with a diagnosis of hypertrophic scar (L91.0) and CPT codes of 11406 (excision of benign lesion) and 12034 (intermediate repair) for the…

132016Apr

Billing Bilateral Procedures

April 14, 2016 Question: I was hoping you could answer a quick coding question for me. For example, in bilateral coding a breast reduction (19318) or a TRAM flap (19367), do I put the codes on one line or 2? Example: 19318-50 or 19318 and 19318-50. Answer: The charge entry format depends on the payer…

312016Mar

New or Existing Patient Coding

March 31, 2016 Question: If I see a new patient for a general plastics issue, then they come back to me for a hand issue two months later, can I bill as a new patient visit the second time? Answer: No, this would be an established patient (99211-99215). If you or another plastic surgeon in…

32016Mar

Use of Tissue Adhesive for Laceration Repair

March 3, 2016 Question: Does use of a tissue adhesive “count” as a layer for the laceration repair codes? Answer: Actually, yes it does! The CPT guidelines state “Use the codes in this section to designate wound closure utilizing sutures, staples, or tissue adhesives (e.g., 2-cyanoacrylate), either singly or in combination with each other, or…

182016Feb

Exchange of Implants After Breast Reconstruction

February 18, 2016 Question: We have a patient who had bilateral mastectomies and had permanent implants placed several years ago. She now wants smaller implants. I have to get precertification for this procedure and am looking at the CPT codes 19328 (implant removal) and 19325 (breast augmentation) for the procedure. Would that be right? Answer:…

22016Feb

Repair of Nasal Vestibular Stenosis

February 2, 2016 Question: I am trying to come up with the right CPT codes for this procedure so we can get it precertified. Can you help? Answer: Yes, you are wise to determine the correct codes for precertification, otherwise the surgery might not be paid if you billed different codes.  Look at 30465 –…

142016Jan

Excision of Skin Lesion

January 14, 2016 Question: I heard you say at a course (you were great, by the way. I learned a lot from you!) that we should wait for a pathology report before billing for excision of skin lesions.  Please explain why.  This may be why I’m not getting paid. Also, when is your next plastic…

172015Dec

Split Thickness Skin Graft

December 17, 2015 Question: The doctor did a split-thickness autograft of the leg. I can’t find the CPT code for this procedure for an adult. I see only CPT codes for infants and children. Can you tell me where the codes for adults are? Answer: There are two stand-alone codes for split thickness skin grafts:…

32015Dec

Split Thickness Skin Graft

12/03/15 Question: Please resolve an internal debate we’re having in our office. Are the STSG codes chosen based on the recipient or the donor site? Answer: Good question, and this is always confusing. CPT says: “Select the appropriate code from 15040-15261 based upon type of autograft and location and size of the defect. The measurements…

52015Nov

ICD-10-CM: Bilateral Procedures

November 5, 2015 Question: Since the new diagnosis codes for absence of the breast includes one specifically for bilateral, will modifier 50 (bilateral procedure) still be required on the CPT code? For example, for bilateral breast reconstruction with a tissue expander and biologic implant, we will use Z90.13 for acquired absence of bilateral breasts and…

222015Oct

7th Character Extension in ICD-10-CM

October 22, 2015 Question: I don’t understand the 7th character extension. Why don’t all codes get the 7th character extension? Answer: Good question! Only certain categories of codes have the 7th character extension requirement. For plastic surgery, the most common categories of codes include injuries (S codes) and other complications such as capsular contractures (T…

162015Oct

Suture Removal

October 16, 2014 Question: I did not operate on this patient but he ended up in my office for suture removal. Isn’t there a code I can bill for removing sutures when placed by another physician? Answer: There is indeed a code for removal of sutures, but only if you do it in under “anesthesia…

242015Sep

Acellular Dermal Matrix Placement for Breast Reconstruction

September 24, 2015 Question: I’m doing bilateral tissue expander breast reconstructions and will be using ADM. Is there a separate code for the ADM? Answer: Yes, there is. In addition to 19357 (Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion) you can report an add-on code, +15777 (Implantation of biologic implant (e.g.,…

102015Sep

ICD-10-CM for Bilateral Conditions

September 10, 2015 Question: I noticed that the ICD-10 codes for many conditions are specific for right and left. I also noticed that some conditions have a specific code for bilateral. But what if the patient has bilateral disease but there is not a diagnosis code for bilateral? Should I use an unspecified code? Answer:…

132015Aug

Holding Claims for Path Reports

August 13, 2015 Question: Do you advise that we hold our claims for excision of skin lesion procedures until after the pathology report is received? That seems to delay our charges and I want to get them billed quickly! Answer: Yes, you need to hold the claim for the excision of skin lesion codes (114xx…

302015Jul

Lipoma Removal

July 30, 2015 Question: I removed a huge lipoma from a patient and it seems like the benign skin lesion removal codes just don’t describe what I’m doing. Is there another code I can use? Answer: Yes! The “soft tissue tumor” codes were introduced into CPT in 2010 and better describe the procedure you are…

162015Jul

Diagnosis Code

July 16, 2015 Question: I do a lot of reconstruction procedures after the Mohs surgeon has removed the skin cancer. I am not removing cancer so it doesn’t seem right to use a cancer diagnosis code. But what diagnosis code should I use? Answer: We recommend using an “open wound” diagnosis code since the purpose…

22015Jul

Panniculectomy

July 2, 2015 Question: How can I get insurance to pay for a panniculectomy? The patient lost 150 pounds and has excessive abdominal skin and subcutaneous tissue. Answer: Good question! Most payers have a medical policy (also known as “medical necessity”) that must be followed to obtain prior approval for the procedure. Ask the payer,…

212015May

Repair of Nasal Vestibular Stenosis

May 21, 2015 Question: I will sometimes do a septoplasty with the repair of nasal vestibular stenosis. Is it OK to bill both codes together? Answer: Yes, it sure is, assuming the documentation supports both separate services. CPT 30520 (septoplasty) is not included in the code for nasal vestibular stenosis repair (30465, Repair of nasal…

92015Apr

Nipple Tattoo in Breast Reconstruction

April 9, 2015 Question: Is it OK to charge the tattooing if it is done a few weeks after the nipple repair/reconstruction (19350)? Answer: Tattooing is part of the nipple reconstruction code, 19350, and not separately billable. If tattooing is going to be the ONLY procedure performed for nipple reconstruction, then bill the appropriate tattooing…

262015Mar

LeFort Fracture Repair

March 26, 2015 Question: Kim, thank you for coming to our practice a few months ago for coding education. You kept everyone’s attention and my partners said they enjoyed the session. I had a coding question and was wondering if you can offer your insight. I have a patient with bilateral LeFort I, II and…

122015Mar

Reporting the ATT Codes More than Once

March 12, 2015 Question: I did a large wound closure of the perineum, buttock and testicles with 5 large separate local flaps (v-y, rotation/advancement and rhomboid). The total area of the defect was very large and required five local flaps for closure. I billed for the 5 flaps separately (14301-59 five times). Medicare paid once…

262015Feb

Nipple Tattoo in Breast Reconstruction

February 26, 2015 Question: Is it ok to charge the tattooing if it is done before the nipple repair/reconstruction (19350)? Answer: Tattooing is part of the nipple reconstruction code, 19350, and not separately billable whether it’s done before or after the nipple reconstruction procedure. If tattooing is going to be the ONLY procedure performed for…

52015Feb

Measuring Square Centimeters

February 5, 2015 Question: I’m confused about how to determine the square centimeters for using the Adjacent Tissue Transfer codes (14000-14302). Can you explain it in terms that I will understand? I’m not a doctor. Answer: I will certainly try! The adjacent tissue transfer codes are used when there is a primary defect that results…

222015Jan

Epidermal Cyst

January 22, 2015 Question: Hello, I was at an ASPS coding conference last year and loved what Kim Pollock had to say! She did a great job and was very informative, I learned a lot from her that weekend. I have a question and was hoping you could give me some insight on it. When…

82015Jan

Removal of JP Drain

January 8, 2015 Question: I see my breast reconstruction patients anywhere from a week to ten days postop to remove the drains. Can I bill for this? Answer: No. This is part of the routine post-op care included in your payment for the surgical procedure and not separately billable.

232014Dec

Weekend Rounds

December 23, 2014 Question: I share weekend call with another practice that I am not affiliated with. Sometimes, when rounding, I check on a few of their patients some of which are their post-ops and some have not had surgery. Since I am not part of their practice is this something I can bill for?…

112014Dec

Weekend Rounds

December 11, 2014 Question: I have just a quick question regarding weekend rounding. I share weekend call with another practice that I am not affiliated with. Sometimes, when rounding, I check on 5-10 of their patients, some of which are their post ops and some have not had surgery. Since I am not part of…

252014Nov

Multiple Biopsies

November 25, 2014 Question: We did multiple biopsies on the same lesion. So we know we can code 11100 for a single lesion and 11101 if we have multiple lesions. But what do we code if we have one lesion where we did multiple biopsies? Are we still OK to use 11101? Answer: CPT 11100…

182014Sep

Reporting 19342 and 11970

September 18, 2014 Question: Over the past 15 years I have taken numerous courses taught by KZA, as has my staff. We have found you, your colleagues at KZA, and the courses all to be wonderful and very beneficial. I was wondering if you could help me with a question I have. The last course…

42014Sep

Adjacent Tissue Transfer (14xxx)

September 4, 2014 Question: I’m reading an operative report and the surgeon says she did “undermining of the incision to close a keloid excision defect.” She wants to use an adjacent tissue transfer code. This documentation doesn’t seem to satisfy the CPT description. What do you think? Answer: We agree with you that the documentation…

212014Aug

Dog Ears

August 21, 2014 Question: When abdominal “dog ears” are excised after breast reconstruction surgery, is it appropriate to report the procedure with tissue rearrangement codes 14000 and 14001 when the dog ears have been excised and flaps were developed and rotated to close the wound? Or, is it more appropriate to use the excision of…

72014Aug

Coding Shoulder Melanoma

August 7, 2014 Question: My doctor documented the following: Excision of a 1.5 cm melanoma from the shoulder with wide undermining to advance the tissues and a layered closure. Can we use an adjacent tissue transfer code, 14000, for this procedure? Answer: No. “Wide undermining to advance tissues” is not an appropriate use of an…

102014Jul

Excision of Uncertain Behavior Lesion

July 10, 2014 Question: I excised a skin lesion and the pathology came back as a giant pigmented nevus. ICD-9 says this is “uncertain behavior,” 238.2. Which CPT code do I use – malignant (116xx) or benign (114xx)? Answer: Great question! It is most appropriate to use the excision of benign skin lesion CPT code…

122014Jun

Microdermabrasion Coding

June 12, 2014 Question: What is your recommendation for the proper CPT-4 coding for microdermabrasion? Many of my colleagues use the codes for dermabrasion (15780-15783). I have also seen unlisted codes used (17999, 96999). Thank you. Answer: There is not a specific CPT code for “microdermabrasion” because generally this is considered a cosmetic procedure and…

292014May

Cranioplasty

May 29, 2014 Question: What is the correct code to bill for a prefabricated polymethylmethacrylate custom cranial implant greater than 5 cm? I, the neurosurgeon, think the code should be 62141 (Cranioplasty for skull defect; larger than 5 cm diameter), but the plastic surgeon who is co-surgeon on this case thinks 62143 (Replacement of bone…

152014May

Closure After Lumpectomy

May 15, 2014 Question: I will frequently do a Wise pattern breast reduction on a breast after a lumpectomy; then I do a breast reduction on the contralateral breast. Is it appropriate to report code 19318 (Reduction mammoplasty) or should I use 19366 for Breast reconstruction with other technique? Or maybe I can use both…

12014May

Carpal Tunnel Release and Splint

May 1, 2014 Question: We put on a splint after a carpal tunnel decompression procedure and my coder says we can separately bill 29125 for the short arm splint. I wouldn’t think we could bill this. What do you think? Answer: You’re right – placement of the splint (or even cast after a fracture repair)…

172014Apr

Adjacent Tissue Transfer

April 17, 2014 Question: We billed an excision of malignant lesion CPT code and an adjacent tissue transfer CPT code and only got paid for the lesion removal. How can we get paid for both services? Answer: The excision of a skin lesion code (114xx, 116xx) is included in the adjacent tissue transfer codes (14000-14302)…

62014Mar

Excision of a Skin Lesion

March 6, 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…

202014Feb

Suture Removal

February 20, 2014 Question: Is there a CPT code for removing sutures in the clinic? Answer: It depends on who put in the sutures. If you put them in and the repair was “intermediate” or “complex” per CPT guidelines, then you cannot charge for removing them because CMS has assigned a 10-day global period to…

62014Feb

Billing 19380 and 20926

February 6, 2014 Question: Is it ok to bill 19380 (Revision of reconstructed breast) and 20926 (Tissue grafts, other (eg, paratenon, fat, dermis) together for excising excess skin on the breast as well as harvesting/injecting fat into multiple breast defects on the same side? Answer: No, 19380 would cover all procedures you describe. Remember, 19380…

232014Jan

Nipple Reconstruction

January 23, 2014 Question: My surgeon is performing bilateral nipple reconstruction with skate flaps and full thickness skin grafts. She would like to use codes 19350 (nipple/areola reconstruction) billed on two lines with LT/RT and 59 modifiefs,15200 (full-thickness graft) on two lines with LT/RT and 59 modifiers and again 15002 (surgical preparation) on two lines…

92014Jan

Rib Resection with Breast Reconstruction

January 9, 2014 Question: I did a breast reconstruction with a free flap, actually a DIEP flap, and billed 19364 for the breast reconstruction as well as 21600 for the rib resection. The insurance company paid me for the breast reconstruction but denied payment on the rib resection. I appealed the denial but lost –…

122013Dec

Excision of a Skin Lesion

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 in size when…

142013Nov

Breast Reconstruction

Question: I’m doing a second stage breast reconstruction revision by removing the tissue expander and placement of a permanent implant. I got two codes pre-certified, 11970 (Replacement of tissue expander with permanent prosthesis) and 19380 (Revision of reconstructed breast). So I billed those two codes but the insurance company only paid one code, 11970. How…

172013Oct

Soft Tissue Tumor Codes

Question: I removed a lipoma from the chest that was a good size and pretty deep. I’m looking at the excision of benign skin lesion codes (114xx) and they just don’t seem to describe what I did. Please help. Answer: Good thing you asked for advice because new codes were introduced in 2010 that better…

52013Sep

Skin Lesion Removal and Closure

Question: I have a question on lesion removal and closure coding. If two lesions the same size, same diagnosis (e.g., malignant) and same area (e.g., neck) are removed, is the code used twice or are the sizes added together for one code? I have the same question for a repair- same site (per code description),…

112013Jul

Complex Closure

Question: One of my doctors wants to bill complex closure codes along with his breast procedure codes (i.e. breast reduction & breast reconstruction). He wants to use them for the closure stating that he is doing a complex layer closure when he closes the patient. He got the idea because he has a “friend who…

272013Jun

Excision of Melanoma

Question: I’ve heard differing advice and hope you will clear up something for me. What CPT code do we use for excision of a melanoma? I’ve heard people say to use the excision of skin lesion code, 116xx, and others tell me to use the soft tissue or radical excision of tumor codes such as…

132013Jun

Calculating Physician Work RVUs

Question: I am confused about how to count RVUs particularly for bilateral procedures such as the bilateral breast reduction surgery. Is the RVU assigned to the code 19318 for one breast or for a bilateral procedure? So for example if the work RVU for 19318 is say 33.12, and I did only one breast would…

302013May

Calculating Size for Codes

Question: I’m new to coding. My doctor and I have a disagreement on how to calculate the size for the adjacent tissue transfer codes (140xxx). The doctor says there was a 16.5 cm by 7 cm wound that he did an adjacent tissue transfer to close. I think I should use a code for a…

162013May

Excision of a Sebaceous Cyst

Question: What diagnosis code do we use for a sebaceous cyst – is it a “benign neoplasm”? Answer: Actually, a sebaceous cyst has its own diagnosis code, 706.2, so use of a neoplasm code is not accurate. You’ll use the excision of benign skin lesion CPT code, 114xx, to report the surgical procedure. Remember, many…

182013Apr

Excision of Uncertain Behavior Skin Lesion

Question: If my physician excises a lesion and the pathologist says it is a diagnosis that is considered “uncertain behavior” by ICD-9, do I use the benign excision of skin lesion CPT code or the malignant CPT code when I bill? Answer: Good question! When the diagnosis is categorized with an “uncertain behavior” ICD-9 code,…

42013Apr

Rib Resection With Breast Reconstruction

Question: I did a breast reconstruction with a free flap, actually a DIEP flap, and billed 19364 for the breast reconstruction as well as 21600 for the rib resection. The insurance company paid me for the breast reconstruction but denied payment on the rib resection. I appealed the denial but lost – they said that…

72013Mar

Removal of K-wire

Question: I repaired a phalangeal fracture on a patient and placed K-wires. I took them out in the office. Is this billable? Answer: No, removal of the K-wire is included in your global surgical package of the fracture repair. However, you may bill if you take the patient to the operating room (use modifier 58…

122013Feb

Nasal Fracture Repair vs. Rhinoplasty

Question: I did an open treatment of a nasal fracture repair and septoplasty on a patient who was in a bar fight two years ago on spring break and had his nose broken. He now has nasal airway obstruction and deviated nasal septum as well as displaced nasal bones. I billed 21335 (Open treatment of…

242013Jan

Multiple Lesions

Question: The doctor removed 3 lesions: 1) left upper back, 2) right upper back, and 3) right lower back. Each lesion was closed in layers. I got the pathology results back and they all were malignant, with clear margins, so I’m ready to code the case. Do I have to use one malignant skin lesion…

272012Dec

Skin Grafts: Donor vs. Recipient Site

Question: I did a paramedian forehead flap (15731) and harvested a split thickness skin graft from the arm to close the donor defect site. I want to use 15120 (Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits) for the STSG recipient site. My coder says I should use…

132012Dec

E&M Exam

Question: I attended a recent ASPS coding course and heard you speak – you were terrific! i didn’t realize how important E&M coding was and more importantly the documentation for it. When consider level 4 and 5 new patient or outpatient consults, I see that a comprehensive physical exam is needed. Should I be using…

152012Nov

Coding for Tissue Expander Fills

Question: We recently attended the coding workshop in Pittsburgh and you did a great job! We have a question about coding tissue expander fills outside the initial global period of the placement for breast reconstruction. In the workshop, you said to use an E&M code for this service. Our question is how/what should be documented…

12012Nov

Component Separation Procedure

Question: My doctor did a component separation technique to close a large abdominal defect created by the general surgeon after repair of a large incisional hernia. Is this closure included in the general surgeon’s code for the hernia repair or can my plastic surgeon bill his own code? If we can bill, what CPT code…

42012Oct

Is This A Consultation?

Question: I saw a first-time patient in my office who was referred to me by her aunt. Can I bill a consultation code? Answer: Good question. While it might seem like a consultation because that’s the service you provided, it is not a consultation from a CPT coding standpoint. First, remember that Medicare (and many…

202012Sep

Squamous Cell Carcinoma Excision

Question: My doctor documented the following: Excision of a 1.5 cm squamous cell carcinoma from the neck with wide undermining to advance the tissues and a layered closure. Can we use an adjacent tissue transfer code, 14040, for this procedure? Answer: Absolutely not. “Wide undermining to advance tissues” is not an appropriate use of an…

62012Sep

Reading an X-ray the Patient Brought In

Question: A patient presents with a CD of an x-ray that was performed at another institution has been previously read by the radiologist, If one of my plastic surgeons looks at and interprets the x-ray can we bill for the second reading? Answer: Actually, the plastic surgeon’s activity or looking at and reading the x-ray…

232012Aug

Le Fort Fractures

Question: I performed open reduction internal fixation of bilateral Le Fort II fractures through multiple approaches. Would this be coded as 21347-50? Otherwise asked, does 21347 constitute a repair of a unilateral Le Fort fracture? Answer: The Le Fort fracture repair codes should not be reported with the bilateral modifier (50). A Le Fort fracture…

92012Aug

Tissue Expander Fills

Question: We did a breast reconstruction with tissue expander three weeks ago and are now starting the expansion process. What is the code for doing tissue expander fills? Answer: The tissue expansion process is included in the global surgical package for the breast reconstruction CPT code (eg, 19357). You may report an established E&M code…

262012Jul

Coding For Rib Resection

Question: I heard rumors that one should also code for a rib resection when performed with a DIEP flap breast reconstruction. Is this correct? Answer: No. CPT 19364 (Breast reconstruction with free flap) includes a partial rib resection (eg, 21600) so this should not be separately reported . Per CPT(R) guidelines, 19364 includes the elevation…

122012Jul

Suture Removal

Question: Is there a CPT code for removing sutures in the clinic? Answer: It depends on who put in the sutures. If you put them in and the repair was “intermediate” or “complex” per CPT guidelines, then you cannot charge for removing them because CMS has assigned a 10-day global period to these codes. If…

282012Jun

DIEP Flap Breast Reconstruction Coding

Question: I did a breast reconstruction with DIEP free flap, exploration and preparation of the right internal mammary artery and vein for microvascular anastomosis, insertion of an indwelling pain catheter to the abdominal wall, insertion of the Doppler probe to flap artery and vein, and partial resection third rib. The codes I bill are: 19499…

142012Jun

Vital Signs for E&M Services

Question: I understand that 3 of 7 vitals must be noted to qualify for a comprehensive exam in a level 4 new patient (99204) visit. My question is whether height and weight can be obtained from the patient to meet this criterion or if we have to actually measure the height and weight. Answer: Any…

312012May

Modifier 51 in Burn Surgery

Question: I have a question concerning the use of modifier 51 in burn surgery and whether carriers are allowed to reduce the RVU by 50% when they apply that modifier. I swear I read somewhere that a 51 modifier no longer means that the RVU can be discounted. Answer: CPT guidelines state that modifier 51…

172012May

Placement of a Seroma Catheter

Question: I had to place a catheter system into a seroma on a postoperative patient. Neither I nor any of my partners did the surgery. The patient showed up in the ER because she was on vacation. I don’t see a code for placing a seroma catheter. How should I bill this? Answer: You are…

32012May

Diagnosis Code for Keratoacanthoma

Question: What diagnosis code and type of excision of lesion CPT code should I use for a keratoacanthoma? Some people say these are benign lesions while I’ve heard others say they are malignant. I’m confused. Answer: Actually the ICD-9-CM coding system states that a keratoacanthoma is coded as 238.2 (Neoplasm of uncertain behavior of other…

122012Apr

Placement of Alloderm for Breast Reconstruction

Question: I’ve always used 15330 (placement of acellular dermal graft) for placing AlloDerm with my tissue expander reconstructions. All of a sudden, the code is being denied by the payors. Help! Answer: As of January 1, 2012, CPT directs physicians to now use the add-on code 15777 (Implantation of biologic implant (eg, acellular dermal matrix)…

152012Mar

Tissue Expander Fills, Again

Question: I keep getting confused on when and what I can bill for tissue expander fills when I’m in, and out of, the global period of the tissue expander placement.  Can you please go over this one more time? Answer: Sure!  The breast reconstruction with tissue expander CPT code (19357) includes all fills during the…

162012Feb

CPT and Diagnosis Codes for a Skin Lesion

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 benign lesion since…

262012Jan

New vs. Established Patient

Question: One of the plastic surgeons in our community joined our practice and he is now seeing his patients in our office. Are these considered new patients (9920x) when they are seen in our practice? We have to make a new chart and get the patients registered in our computer and that’s a lot of…