Surgical Coding: Follow Hernia Bundling Rules

Posted on 23. Apr, 2010 by Editor.

Did you factor in a foreign body removal code?

Question: During an open hernia repair for a reducible umbilical hernia, the surgeon finds a sizeable gallstone embedded in the omentum extending into the preperitoneal fat. The surgeon excises the gallstone granuloma with cautery. Patient history indicates cholecystectomy eight years ago. What are the correct ICD-9 and CPT codes?

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Answer: The proper procedure code for this scenario is 49585 (Repair umbilical hernia, age 5 years or older; reducible). If the gallstone resection represents a significant amount of extra time and effort, modifier 22 (Increased procedural services) would be appropriate.

Watch out: You should not report the omentum gallstone resection (49255, Omentectomy, epiploectomy, resection of omentum [separate procedure]) in addition to the 49585 hernia repair. As a designated “separate procedure” code, you should only list 49255 if it is the only procedure the surgeon performs at the site.

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How Do I Code An Arthroscopic To Open Ankle Surgery?

Posted on 04. Jan, 2010 by .

Question: Our surgeon attempted to remove a loose body in the ankle arthroscopically, but it was too large so he had to perform an open removal. Do I bill only for the open procedure, or include the arthroscopic attempt as a discontinued procedure?

Answer: Because your surgeon completed the procedure as an open case, you’ll report only 27620 (Arthrotomy, ankle, with joint exploration, with or without biopsy, with or without removal of loose or foreign body) Include V64.43 (Arthroscopic surgical procedure converted to open procedure) as a secondary diagnosis.

Arthroscopic answer: If the physician had completed the procedure arthroscopically, you would submit 29894 (Arthroscopy, ankle, [tibiotalar and fibulotalar joints], surgical; with removal of loose body or foreign body) instead.

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Orthopedic Coders: Do you understand the new consult coding rules? Get clear answers from our 2010 orthopedic coding audio update on January 7th.

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Coding Challenge: Foot Foreign Body Removal Vs. Soft-Tissue FBR

Posted on 16. Jun, 2009 by .

Question: Our physician performed a foreign-body removal (FBR) on a patient with a splinter in the subcutaneous tissues of his left foot. We reported 10120 and received a denial. Should I appeal, or did I code improperly?

Answer: : In this case, there is a more specific code for a foot FBR. Code 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) is in the “Integumentary” part of CPT’s “Surgery” section. It is for simple, subcutaneous incision and removal of foreign bodies when no more specific code exists.

For reporting subcutaneous FBRs from the foot, a more specific code does exist.

When your physician removes a foreign body from a patient’s foot, choose from:

• 28190 — Removal of foreign body, foot; subcutaneous

• 28192 — … deep

• 28193 — … complicated.

Ahhh, Summer. That’s means FBRs, sunburn diagnosis coding challenges, tetanus denials & more. Tackle them all with Jen Godreau’s Summer Coding Survival Guide.

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Know What Separates FBR From E/M or Lose $80 in Pay

Posted on 26. Feb, 2009 by .

Here’s why ‘incision’ with non-scalpel instrument could be an FBR.

If you cannot spot simple or complicated foreign body removal (FBR) qualifiers, you could end up costing the ED more than $80 for a simple removal, or more than double that per complex episode. Galvanize your soft-tissue FBR coding skills with this expert advice.

ED Coders: Don’t miss the chance to learn from Caral Edelberg, Kenneth Engel & Dr. Jeffrey Linzer in Orlando this summer.

Follow CPT for FBR Definition

Coding for soft-tissue FBRs seems simple enough: A patient reports to the ED with an FB, the physician removes it, and you choose an FBR CPT code.

Not so fast: The above scenario might be an FBR, but it might also be an E/M service. To report one of the soft-tissue FBR codes, the encounter should fit the following description, from Joshua Tepperberg, CPC, EMT-D: The provider makes an incision to the overlying skin, and then removes the FB.

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