Hot Coding Topics / Provider News

Two New CPT Codes Lend Specificity to Interstitial Device Coding

Until now, you could not code for the additional service — and hence not get the pay — when your general surgeon placed interstitial devices for radiation therapy guidance during a distinct open or laparoscopic abdominal procedure. But two new CPT 2011 codes for the procedure help you capture all the pay you deserve.

Open, Lap, or Percutaneous Approach Distinguish Placement

Last year, you had one code to use when your surgeon placed an abdominal interstitial device for radiation therapy guidance — 49411 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], percutaneous, intra-abdominal, intra-pelvic [except prostate], and/or retroperitoneum, single or multiple).

“If your surgeon performed the device placement during an open or laparoscopic procedure prior to 2011, you had no way to capture the service,” says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program in Seattle.

Now CPT 2011 adds two new add-on codes to describe interstitial device placement during another procedure, as follows:

  • +49327 — Laparoscopy, surgical; with placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple [List separately in addition to code for primary procedure])
  • +49412 — Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], open, intra-abdominal, intrapelvic, and/or retroperitoneum, including image guidance, if performed, single or multiple [List separately in addition to code for primary procedure]).

Choose +49327 for a laparoscopic approach, and +49412 for an open procedure. “Note that these are add-on codes, which means you can report them only in addition to a primary procedure,” Bucknam advises.

Continue to report 49411 for percutaneous interstitial device placement as a stand-alone procedure.

Use codes 49411, +49412, and +49327...

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April 2, 2011
Coder's Cranium

59400, 99212, 99213: How to Add Complication Visits to the Global Ob Package

Hint: You can report complications before or after delivery.

You can receive increased reimbursement when your ob-gyn provides additional visits outside of the normal global ob package, but you’ll have to make sure you’ve coded high-risk or complicated obstetrical care correctly – and that means perfecting your ICD-9 coding skills.

Insist on Perfect ICD-9s

You have to link the ICD-9 code on the CMS-1500 claim form (boxes 21 and 24E) to an E/M code, for example, to demonstrate the reason for the additional service. You can add this to the claim that includes the global service, or you can submit it as an additional claim.

Example: A 33-year-old patient, gravida 3, para 2 (both normal spontaneous vaginal delivery [NSVD] full term), is seen in the office 19 times due to developing pre-eclampsia. After the delivery, you review the case and find that the patient required six additional visits (beyond the usual 13) for this care. The documentation for three of these visits supports reporting 99212 (Office or other outpatient visit for the evaluation and management of an established patient … Physicians typically spend 10 minutes face-to-face with the patient and/or family), while three of the visits have more extensive documentation that supports reporting 99213 (Office or other outpatient visit for the evaluation and management of an established patient … Physicians typically spend 15 minutes face-to-face with the patient and/or family).

In addition, after delivery, the patient experiences prolonged pain and irritation due to a hemorrhoid. The ob-gyn sees her for a thrombosed hemorrhoid, which he incises in the office two weeks post-delivery. Finally, the ob-gyn rechecks the patient at her six weeks postpartum visit.

Break it down: When coding for this patient, remember the claim form must note both the CPT codes describing the additional services, as well as the diagnoses that...

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November 14, 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:

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January 19, 2010