Coding Challenge / CPT / surgery

Surgical Coders: Don’t Overstate Debridement

Tip: This encounter involves topical applications and patient care instruction in addition to removing devitalized tissue.

Question: When the surgeon performs a wound VAC or cleans a wound by scraping with a sharp curette (not excising tissue), is it appropriate to use a debridement code or should we report an active wound care management code from the range 97597-97606?

Ohio Subscriber

Answer: Physicians typically use the debridement codes (11000-11001, Debridement of extensive eczematous or infected skin; … or 11004-11005, Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; …) for debridement by any method.

Without...

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May 20, 2010
CMS / Hot Coding Topics / modifier PA / modifier PB / modifier PC / modifier TC / Modifiers / surgery

Surgical Modifiers: Protect Yourself From Instant ‘PC’ Claim Denials

Don’t let ‘wrong surgery’ modifier mistakes stall your reimbursement.

You use modifier TC for the technical component of a test. So logically, you should use modifier PC for the professional component, right? Wrong. But many coders are making that mistake...

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March 18, 2010
Hot Coding Topics / surgery

Stay in the Game With the Correct Ligament Repair, Reconstruction Codes

Remember ligament repair abbreviations to simplify elbow ligament surgeries.

Baseball players are gearing up for the season, which means your orthopedist could see a sudden increase in elbow ligament injuries. If conservative therapies fail to help torn medial (841.1) or…

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March 2, 2010
Coder's Cranium / surgery

Factor Location and Depth into Foreign-Body Removals

Explore these three “what if” scenarios to perfect your FBR claims. Your foreign-body removal (FBR) coding can vary greatly depending on the type of foreign body, its anatomic location, and the depth from which the physician must remove it. Here are three case studies to help you find your way. Case 1: No Incision Means No Separate [...] Related articles:

  1. Coding Challenge: Foot Foreign Body Removal Vs. Soft-Tissue FBRQuestion: Our physician performed a foreign-body removal (FBR) on a...
  2. Know What Separates FBR From E/M or Lose $80 in Pay Here’s why ‘incision’ with non-scalpel instrument could be an...
  3. Burn Coding: Calculate Total Body Surface Area (TBSA)Investigate your physician’s documentation to determine the body area percentage...

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February 15, 2010
CPT / ICD-9 / modifier 22 / modifier 52 / modifier 59 / Modifiers / surgery / Toolkit

8 Simple Steps Organize Your Op Note Coding

This aspect of op note coding is the “horse that pulls the cart.” Stuck on how to tackle this op note or those sitting on your desk? Follow this advice, provided by Melanie Witt, RN, CPC, COBGC, MA, an ob-gyn coding expert based in Guadalupita, N.M. and co-presenter of the “Ob-Gyn Op Notes” session at the [...] Related articles:

  1. 3 Steps Take the Guesswork Out of Coding Vaginal Cuff Repairs Find out what colporrhaphy code you’ll use for an...
  2. Write an Appeals Letter That Works In 6 Simple Steps Transform the written word into reimbursement with these tips...
  3. Op Note Coding Clinic: Breast Reconstruction with AlloDermSurgeons now commonly use AlloDerm in a variety of surgeries,...

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February 11, 2010
CCI / Coding Challenge / surgery

Surgery Coding Challenge: Master Microsurgery Units With This Advice

Check your EOB to make sure payers don’t apply a multiple-procedure reduction to +69990. Question: When my ENT uses a microscope during a procedure, what guidelines can I use for choosing between 92504 and +69990? Is there a rule governing how many times you can report the add-on code 69990? Answer… You can use 92504 (Binocular microscopy [separate [...] Related articles:

  1. Spinal Surgery Coding Challenge: Tethered Cord Release & Dural Tag RemovalQuestion: My neurosurgeon released a tethered cord under the microscope,...
  2. Know Your Magnifiers for Microscope Coding Success Your ENT has invested training time and money in...
  3. Take Our Multi-Level Spinal Surgery Coding Challenge AUDIO TRAINING EVENT: Receive Optimum Reimbursement for Spinal Co-Surgeries,...

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January 28, 2010
Coder's Cranium / surgery

Time Your Surgical Collections Right by Referencing Payer Contracts

Find out if you’re legal in collecting patient portion before providing the surgical service. Don’t be too hasty in collecting a patient’s copay and deductible up front. “While in theory, the practice of collecting deductibles up front may sound good, you should check your carrier contracts to be sure you are allowed to do this before requesting [...] Related articles:

  1. Checklist: Collect Surgical Deductibles Up Front to Improve A/RThis 3-step checklist will boost your bottom line. With fewer...
  2. Medical Billers: Test Your Collections Know-How Here This nifty tool tells you if collections cluelessness is...
  3. 10 Carrier Contract Negotiation Tips Carrier contract negotiation is often a long, difficult process....

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January 21, 2010
Hot Coding Topics / modifier 58 / modifier 78 / modifier 79 / surgery

Second Surgery Coding: Tips for Modifier 58, 78 Success

Don’t let ‘unplanned’ lead to ‘unpaid.’ The next time a patient takes an extra trip to the operating room, don’t let the added service throw your coding off track. Keep these tips in mind to know when to assign modifier 78 – or something else. Check for Surprise Versus Planned Two modifiers pertain to follow-up trips to the [...] Related articles:

  1. Bone Up On ASC Orthopedic Coding With These Global Period, Modifier Tips 3 ways your physician claim better look different than...
  2. Global Billing: Document ‘Unrelated’ for Modifier 79 ServicesMACs are looking for ‘red flags’ to halt additional global period pay...
  3. Decision Chart: Modifier 78, 58, or 79?Simplify your post operative service claims with this nifty tool....

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January 19, 2010
Coding Challenge / surgery

Surgical Coding: Scar Revision on Previous Mastectomy Site

Tip: Find mastectomy scar revision in wound repair Question: Our surgeon performed a scar revision on the site of a previous mastectomy. The procedure involved excising a 16.5 cm curved scar before performing a layered closure. How should we code this? Answer: You should use complex wound repair codes for the scar revision procedure that you describe. [...] Related articles:

  1. Surgical Coding Mysteries: The Case of the Separate MeshBeware Separate Mesh Removal Question: The surgeon performed the following:...
  2. Surgical Coding: Modifiers 58, 78, and 79SURGICAL MODIFIER CHOICES Surgery Modifier Choices are Key to Surgery...
  3. Partial Mastectomy Coding: 19302 Vs. 19301 Plus 38500 Here’s how you know when to include a lymph...

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December 14, 2009
Coding Challenge / surgery

Surgical Coding Mysteries: The Case of the Separate Mesh

Beware Separate Mesh Removal Question: The surgeon performed the following: Made 10 cm supraumbilical transverse incision with 15-blade scalpel carried down through subcutaneous tissue using Bovie. Used combination electrocautery and blunted dissection to isolate area of scar tissue on patient’s right side. Noted sutures from previous umbilical hernia repair and mesh from right-lower abdominal hernia repair. Excised [...] Related articles:

  1. Don’t Mesh Up Your +57267 CodingAn ob-gyn doc with coding know-how tells us how to...
  2. What a Mesh! (+57267)Take this advice to avoid messing up your mesh coding:...
  3. Surgical Coding: Modifiers 58, 78, and 79SURGICAL MODIFIER CHOICES Surgery Modifier Choices are Key to Surgery...

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November 21, 2009