Archive for 'Coding Challenge'
Posted on 17. Aug, 2009 by .
Question: The dermatologist treated an established patient with a cut on her lip and used Dermabond to close the 1.8-cm laceration. Should I use a laceration repair code when the only adhesive he used was Dermabond?
Answer: Your code choice will depend on the patient’s insurance. Check out these two coding options:
Patient has Medicare: If the physician uses Dermabond as the only closure material for a simple repair on a Medicare patient, report G0168 (Wound closure utilizing tissue adhesive[s] only) for the service.
Patient has commercial insurance: If the commercial carrier follows Medicare rules, use G0168. However, if the payer does not observe Medicare guidelines, you’ll most likely choose a laceration repair code, even when Dermabond is the only adhesive the physician uses. On the claim, report 12011 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less).
Either way: Append 873.43 (Other open wound of head; face, without mention of complication; lip) to the procedure code to represent the patient’s injury.
Posted on 14. Aug, 2009 by .
Answer: The procedure removes adhesions (tags) from the dura to correct any neurological deficits. Physicians often remove a specimen to send for lab review, but that service is included in the primary procedure.
In this situation, you’ll report 63200 (Laminectomy, with release of tethered spinal cord, lumbar) for the cord release and +69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) for the microscope use. Don’t report the dural tag removal separately, as it is incidental to the tethered cord release.
Posted on 12. Aug, 2009 by .
Question: Our dermatologist shaved three epidermal lesions that the patient chose not to have submitted to pathology: a 0.4 cm lesion from the patient’s chest, a 0.3 lesion from the patient’s back, and a 0.2 lesion from the patient’s stomach. Will I need to include modifiers?
Answer: Because CPT classifies the shaves with the same anatomic area and size code, you will need a modifier on the second and third shave removal codes. Without the modifiers, the insurer’s software system may throw out the additional shaves as duplicates.
You should technically use modifier 51 (Multiple procedures) on the second shave (11300, Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less). Then separate the third excision from the second with modifier 59 (Distinct procedural service). The claim would contain: 11300, 11300-51, and 11300-59.
If you’re reporting the claim to a Medicare carrier, omit modifier 51. Medicare’s computer editing system automatically considers eligible additional procedures multiple without requiring modifier 51. Because of this, Medicare would deny your line item of 13000-51. You could append modifier 59 (Distinct procedural service) instead: 13000, 13000-59, and 13000-59.
Posted on 10. Aug, 2009 by .
Question: My orthopedist treated a patient who was first seen in the ER for an open fracture with laceration overlying the distal finger phalanx. The ER physician sutured the wound. When the patient arrives in our office, the orthopedist does an E/M service and assumes the care of the wound in addition to the fracture care. Should I report our orthopedist’s E/M service or does that qualify as double-dipping?
Answer: If your orthopedist didn’t do anything in addition to treating the fracture (such as splinting, casting, and so on), then you should bill the E/M service (such as 99214, Office or other outpatient visit …). You might try applying modifier 55 (Postoperative management only), but you need to make sure the service the ER physician performed has more than a “0” day global. Many wound repair codes are minor procedures that have 10 day global periods.
If your orthopedist treated the fracture, you should report the appropriate fracture code. Your facture code could be 26750, Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each, or 26755, … with manipulation, each, depending on whether the orthopedist performed the manipulation).
Posted on 07. Aug, 2009 by .
Question: How should I report the placement of gold seed markers and a TRUS done in the office setting?
Answer: First, you should report 55876 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], prostate [via needle, any approach], single or multiple) for the gold seed marker placement. If the urologist also examined the prostate gland transrectally with ultrasound, report 76872 (Ultrasound, transrectal) for the transrectal ultrasound (TRUS).
You should also report 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) for the ultrasound guidance your urologist used to place the gold seed markers.
Plus: For the actual cost of the markers, also report A4648 (Tissue marker, implantable, any type, each). Some payers will request your patient’s invoice before paying for the markers, while others will never pay for this code.
Posted on 05. Aug, 2009 by .
Answer: Since the physician performed the debridement and the notes indicate that it was an excisional debridement, you should report 11040 (Debridement; skin, partial thickness) for the service.
Key: Physician role should drive your debridement coding. Coders typically choose 97597 (Removal of devitalized tissue from wound[s], selective debridement, without anesthesia [e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps] …) when non-physician providers (physical therapists, wound care nurses, etc.) perform non-surgical debridement on a patient’s wound. If a physician such as a dermatologist performs a surgical debridement, choose from the debridement codes (11040-11044).
Posted on 03. Aug, 2009 by .
Question: A patient has pressure sores that were 20 sq cm on his right ankle and right hip that the dermatologist debrided in the morning. Because of the patient’s condition, selective debridement of a 17 sq cm sacral pressure sore was performed at a separate session in the afternoon on that same date by the same physician.
Answer: Report modifier 76 (Repeat procedure or service by same physician) when the same physician has to duplicate the same procedure (such as when the first was unsuccessful). Therefore, you should use modifier 59 (Distinct procedural service), rather than modifier 76.
Use modifier 59 when documentation shows that medically necessary circumstances, such as separate sessions, make reporting two codes that would not normally be reported together acceptable. In your case, the dermatologist would report the same debridement code (such as 11040, Debridement; skin, partial thickness) with modifier 59 appended in the second instance. Without modifier 59, the insurer’s software edit system may kick out the second 11040 as duplicate to the first.
Posted on 31. Jul, 2009 by .
Question: Our nonphysician practitioner (NPP) discovers a pair of benign lesions on a patient’s right hand. One of the lesions was 0.5 cm, and the other was 0.3 cm; the injuries were 1.0 cm apart. Using a scalpel, the NPP removes both lesions with a single excision. Should I report one or two excision codes?
Answer: Since the NPP performed both excisions with a single incision, you should group the excisions together and report one code for both. Add the lengths of the two excisions to the margin between the lesions, and choose a code based on that length. (In your scenario, 0.5 + 0.3 + 1.0 = 1.8 cm.). On the claim, report 11422 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm) for the excision.
Posted on 29. Jul, 2009 by .
Question: We received a mastectomy specimen based on a prior cancerous biopsy but find no residual tumor. How should we code the mastectomy (procedure and diagnosis)?
Answer: The final diagnosis for a mastectomy specimen doesn’t change your procedure coding. You don’t mention lymph nodes, so you should report the pathologist’s mastectomy examination as 88307 (Level V –Surgical pathology, gross and microscopic examination, breast, mastectomy – partial/ simple), regardless of the final diagnosis.
Diagnosis coding rules require you to report the most specific diagnosis available at the time. Here’s 3 steps that ensure you do just that:
1.If you have the pathologist’s report and it includes a definitive diagnosis, you should use that diagnosis.
Posted on 27. Jul, 2009 by .
Question: If I’m reporting 92980 and 92981’s professional component, may I report 93508, too?
Answer: If you use 93508 (Catheter placement in coronary artery[s], arterial coronary conduit[s], and/or venous coronary bypass graft[s] for coronary angiography without concomitant left heart catheterization) to represent a diagnostic procedure, you should be able to report it alongside 92980 and +92981 (Transcatheter placement of an intracoronary stent[s] ...). But as AMA’s CPT Assistant (August 2000) states, you should not use 93508 to report the necessary catheter insertion for a percutaneous intracoronary stent procedure.
Reason: AMA’s CPT: 2009, Professional Edition, explains that 93508 describes a cardiac catheterization in which the cath doesn’t cross the aortic valve into the left ventricle. CPT didn’t intend 93508 to describe roadmapping.
Snag: Correct Coding Initiative (CCI) edits don’t bundle 93508 into 92980, but you may need to append modifier 59 (Distinct procedural service) to 93508 for some payers. You may have to appeal, explaining that 93508 represents a diagnostic procedure separate from the stent placement. But coders report that certain payers won’t cover 93508 on the same day as 92980 even after appeal.