Tag Archives: general surgery
Posted on 30. Dec, 2009 by .
Reporting your general surgeon’s service with an unlisted code means more documentation work and a payment guessing game — that’s why you’ll welcome CPT 2010’s more specific codes.
General surgery can get all the details at this on-demand, specialty-specific audio update. But we won’t keep you in complete suspense. Here’s a peek at what you’ll learn in the audio.
Capture Large Abdominal Repairs With New Code
When your general surgeon repairs a large abdominal wall defect, you didn’t have a way to report the work — until now.
Posted on 01. Jul, 2009 by .
Surgeons now commonly use AlloDerm in a variety of surgeries, including breast reconstruction procedures. This product and the work associated with using it can present some unique coding challenges, and there are some big coding changes that take effect July 1.
Let our experts help you sort through some of the breast reconstruction surgery coding myths you might encounter. Uncover the truth about AlloDerm coding using this case study presented by Dolores D. Carey, CCS-P, physician-based coder for Loyola University Physician Foundation in Maywood, Ill.
Operative note: The surgeon performed a bilateral mastectomy. He created a submuscular pocket on the patient’s left side after achieving meticulous hemostasis and removing the pec inferiorly. He placed an implant — medium-height Contour Profile Mentor 275cc — into the pocket after achieving meticulous hemostasis. Next, the surgeon fashioned AlloDerm acellular dermis for the inferior pole in a standard fashion and sutured it in place with #2-0 PDS sutures after a fill of 120cc over a drain. He then performed the exact same procedure on the patient’s right side. Once satisfied, the surgeon placed the patient in a seated position and noted the implants were in good position related to her cleavage and inframammary fold. He placed the patient back in the supine position. He copiously irrigated the region using antibiotics solutions, placed drains, and closed.
Myth #1: Report 15330-15336 for Sling Placement
When your surgeon uses AlloDerm during breast reconstruction, you may think you should code 15330 (Acellular dermal allograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children), and then add +15331 (… each additional 100 sq cm, or each additional 1%…
Posted on 29. May, 2009 by .
Question: In accordance with the new laparoscopic hernia codes, does 49652 incorporate the hiatal hernia repair? I was told that epigastric hernia repair is the same, but our surgeon does not agree. What is the correct code to use for laparoscopic repair of hiatal hernia?
Answer: CPT does not contain a specific code to describe laparoscopic hiatal hernia repair, even with the addition of the new laparoscopic hernia repair codes this year. Therefore, to describe a procedure of this type, you must select the unlisted procedure code 39599 (Unlisted procedure, diaphragm).
If the surgeon performed an open hiatal hernia repair, however, you would select 39520 (Repair, diaphragmatic hernia [esophageal hiatal]; transthoracic) for a transthoracic approach, or choose between 39530 (…combined, thoracoabdominal) and 39531 (… combined, thoracoabdominal, with dilation of stricture [with or without gastroplasty]), as appropriate.
Clinical rationale: Your surgeon is correct that an epigastric hernia is not the same as a hiatal hernia. An epigastric hernia is usually through anterior wall fascia, above the umbilicus and below the zyphoid. The hiatal hernia is internal, at the esophageal hiatus where the esophagus transits the chest cavity to the abdominal cavity.
Posted on 14. Apr, 2009 by .
At the end of last week, the Las Vegas airport was full of coders leaving the AAPC National Conference, and our heads were full of reimbursement to-do lists for our return to the office.
Here’s a tip for trauma surgery coders from Suzan Berman-Hvizdash, who presented at the conference along with trauma surgeon Dr. Louis Alcaron.
“If you remember nothing else from this conference” (and some of us won’t), talk to your local payers about the -ST modifier,” Suzan urged attendees. If your payers accept the ST modifier, you can really boost your reimbursement for a trauma patient’s care.
If the payer allows it, you can add the -ST modifier to every procedure and E/M encounter associated with the trauma patient’s care, as long as the care is related to the trauma. If an endocrinologist comes in to manage the patient’s diabetes while the patient is in the hospital, for example, you wouldn’t append -ST to that E/M encounter.
Posted on 17. Mar, 2009 by .
Good news: There’s a fast and easy way to determine if a code is a base code: Consult the Medicare Physician Fee Schedule (PFS), says Jill Young, CPC, CEDC, CIMC, of Young Medical Consulting in East Lansing, Mich. You can download the PFS from CMS for free here. Be sure to download the “PFS relative value files” version. Then select “2009” to download the fee schedule.
How it works: To identify an endoscopic base code, look to column AD (labeled “Endo Base”) of the Excel spreadsheet you download. Column AD shows you the endoscopic base code for the code that appears in column A.
Important: If there is no code in column AD, the code in column A is the base code or is not an endoscopic procedure code at all.
Posted on 17. Mar, 2009 by .
Are you sure you’re capturing every dollar your physicians deserve when they perform multiple scope procedures in one surgical session? There are times when you can report multiple scope procedures together, but if you don’t know what they are you could be leaving money on the table.
Check Parent Codes Before Billing Multiple Scopes
Colonoscopies, small bowel endoscopies, and anoscopies are all endoscopic procedures. The first question you need to ask when coding multiple endoscopic procedures during the same surgical session is: Are the endoscopies the surgeon performed in the same code “family”?
Pointer: If the answer is yes, the multiple-scope rule specifies that you cannot report the base, or “parent,” code separately with a more extensive endoscopy in that same code family.
Posted on 22. Feb, 2009 by .
If you get frustrated sorting through all the lines of edits in the Correct Coding Initiative (CCI) files, refer to this easy-to-decipher chart to know what new code pairs you may separate with a modifier, and what codes carriers will never pay for.
Note: The code in the left column (column 1) represents the comprehensive code. The bundled codes are in column 2, and the modifier indicator is in column 3.