Question: If our surgeon removes a sebaceous cyst from the back that measures 2.5 x 1.75 x 0.5 cm, should we add up all the dimensions or should we just use the biggest dimension of 2.5? Is the answer the same if this were a tumor instead of a cyst?
Question: Our state’s Medicaid carrier denies our claims when we submit 62311 with modifier 59 for postoperative pain management. They say the 62311 is bundled with the anesthesia procedure code. How should we handle this? -Ohio Subscriber Answer: ...
Question:
How should I file a claim on a patient who has new coverage but has not received an insurance identification card yet? (South Carolina Subscriber)
Answer:
Ideally, when patients call to make appointments, you should have someone in your office confirm their insurance coverage and eligibility, especially if you know the patient is going to have new insurance. Now is the time of year when benefits verification tends to be most useful. While verification is good practice all year long, January is the time when you’ll see more insurance changes – including payer, benefit, and deductible/copay changes – than at any other time during the year because most employers hold open enrollment in December.
Finding out about insurance changes before the appointment gives you time to check if you are a participating provider with the payer and verify coverage. If the patient doesn’t yet have an identification number with her new insurance company, ask for the name of the insurer and the policy number from the patient, or from the patient’s employer. Then, call the insurer and verify the coverage and the date of eligibility, and get the appropriate information to identify the patient on your claim.
Warning: The date of eligibility is an important question to ask the payer because many employers don’t make health insurance coverage immediately available to new workers. A patient with a new job and new insurance coverage may be in your office for a visit today, but his insurance isn’t effective for two months.
Alternative: Although verifying coverage in advance is preferable, many practices have patients confirm their insurance coverage and note any changes when they check in for their appointments. If you are unable to verify the insurance coverage, or you find that the patient is not eligible for coverage on...
You have two options depending on how the physician performed the procedure.
Question: Our orthopedist administered a hip injection under fluoroscopy. Can I report both codes?
Wyoming Subscriber
Answer: You can code both the injection and fluoroscopy, but the correct choices depend on how your physician completed the procedure.
Option 1: If your orthopedist injected radiopaque dye and performed the arthrography concurrently, code the procedure with 27093 (Injection procedure for hip arthrography; without anesthesia).
Option 2: If he completed the guidance and injection as separate procedures, submit 20610 (Arthrocentesis, aspiration, and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) for the injection. Include 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) for the fluoroscopic guidance.
Remember to append modifier 26 (Professional component) to 77002 because your physician performed the service but doesn’t own the fluoroscopy equipment.
SI change: If the physician injects the sacroiliac joint instead of the hip joint, choose either 20610 (Arthrocentesis, aspiration, and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) or 27096 (Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid).
@ Orthopedic Coding Alert. Editor: Leigh DeLozier, CPC
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If you have a question, be sure to ask your physician.
Question: A patient reports to the ER at 8 a.m. on a Sunday morning. He reports a horrible toothache that started on Friday; he says he planned to “tough it out” over the weekend and see his dentist Monday, but the pain was too severe; he reports 10 on a 10-point pain scale. The ER physician performs an “inf. Aveo block,” according to the notes. What condition do the notes reflect, and how should I code this scenario?
Massachusetts Subscriber
Answer: You should double-check with the physician before filing...
Be careful — the similarity to a laser procedure may deceive you.
Question: My urologist is performing a new procedure called a “button TURP.” I thought 52601 or 53852 might be correct, but now I’m thinking an unlisted procedure code may be more appropriate. What code should I use for this procedure?
California Subscriber
Answer: You should report 52601 (Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included]) for the button transurethral resection of the prostate (TURP) procedure.
Why: The button TURP is a bipolar...
Even though Medicare no longer accepts consult codes, you can still apply modifier 57.
Question: In our ob-gyn office, we used to apply modifier 57 to inpatient consult codes. Now that Medicare doesn’t accept consult codes, how should we use...
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...
Tip: Bill for the exact units given per patient.
Question: My neurologist scheduled two patients back-to-back for botulinum type B injections. But he didn’t use all of the Botox and we disposed of it. Do I need to report the...
Decipher what column 1/column 2 means in this neurosurgery bundle example.
Question: Would you explain what the differences are between mutually exclusive and “column 1/column 2″ edits that come from the Correct Coding Initiative (CCI)?
Florida Subscriber
Answer: Mutually exclusive...
Discover why coding a myofascial flap twice is a big mistake.
Question: Our surgeon performs an abdominal closure using left and right myofascial advancement flaps. I believe we should code one unit of 15734 because flap codes refer to the...
Find out which you can report separately: a tunneled or a non-tunneled line.
Question: What code should we bill when we remove a central venous pressure (CVP) line and insert a Hickman catheter at a different site?
New York Subscriber…
Bonus: Get exposure to ICD-10 coding equivalents.
Question: A mentally-challenged patient who delivered at home was admitted to the hospital for postpartum care. The patient delivered the placenta at home, and once admitted, she had no complications, but the ob-gyn…
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Split Postoperative Cataract Care Question: An ophthalmic surgeon performs cataract surgery, and then turns the patient over to the optometrist for postoperative management only. How should I code between the two providers? Do I need a modifier? Washington Subscriber Answer: If the ophthalmic surgeon turns the patient over to the optometrist for all 90 days of postoperative care, the optometrist will report 66984 [...] Related articles: