Reader Question: Billing for Resident Services at Teaching Hospital   (September 2001)

Question: Does an attending physician have to be in the hospital to bill for any service performed by a resident? If so, what happens if the resident performs a consult on day one at 11 p.m. and no attending physician is present? Can the attending surgeon bill for the consult and date the bill for day two, when he actually reviews the data, even if the consult is dictated and dated day one? Or should [...]

CCI 7.2 Adds Hundreds of Surgery Edits   (August 2001)

Version 7.2 of the national Correct Coding Initiative (CCI), effective July 1, includes many edits of interest to general surgeons. Of particular note are changes for the following five procedures, which are now bundled with hundreds of other codes:
49000 – exploratory laparotomy, exploratory celiotomy with or without biopsy(s)(separate procedure)
49002 – reopening of recent laparotomy 
44200 – laparoscopy, surgical; enterolysis (freeing of intestinal adhesion)(separate procedure) 
G0168 – wound closure utilizing tissue adhesive(s) only 
97601 – removal of devitalized tissue from wound; selective debridement, without [...]

Surgeons Urged To Subscribe to CCI   (August 2001)

The sheer number of national Correct Coding Initiative edits that affect general surgeons in version 7.2  is perhaps the best reason to subscribe to CCIs quarterly updates. If you perform more than one procedure during the same session, you have to check if they are bundled. The only way to do that is by having the most recent edition of the CCI, says Susan Callaway, CPC, CCS-P, an independent coding and reimbursement specialist and educator in [...]

You Be the Coder: Colostomy/Colectomy   (August 2001)

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: How should I code this session: end descending colostomy with mucous fistula; cholecystectomy; and release of small bowel obstruction secondary to adhesions to an area of probable abscess formation in the pelvis?Arizona Subscriber

Answer: The answer depends on whether a section of the colon was removed, says Elaine Elliott, CPC, a general surgery coding and reimbursement [...]

Trach Tips: Coding Strategies To Optimize Reimbursement   (August 2001)

General surgeons usually perform a tracheostomy (trach) for one of two reasons: the patient requires an emergency trach because of an airway obstruction or a planned trach is performed on a patient who can no longer tolerate intubation, says Marcella Bucknam, CPC, billing and compliance manager for the department of surgery at the University of Nebraska in Omaha.  Surgeons will not keep patients intubated for much longer than 10 days, Bucknam says. Therefore, if the [...]

Reader Question: Stent To Support AAA Endograft not Payable   (August 2001)

Question: Your February 2001 article about new codes for AAA repairs did not discuss the implantation of self-expanding stents. The Ancure endograft limbs are unsupported. On occasion, the completion arteriogram may demonstrate the appearance of a stenosis of one or both limbs due to plaque or tortuous vessels. In this instance, do you agree that implantation of a self-expanding stent is indicated and clearly a separate and distinct service and not part of a routine endograft [...]

Reader Question: Laparoscopic Repair of Diaphragmatic Hernia   (August 2001)

Question: How can I code laparoscopic repair of a diaphragmatic hernia?New Hampshire Subscriber
 Answer: There is no code for this procedure, says Marcella Bucknam, CPC, billing and compliance coordinator at the University of Nebraska Medical Centers department of surgery in Omaha. This service is included in a laparoscopic Nissen procedure (43280, laparoscopy, surgical, esophagogastric fundoplasty [e.g., Nissen, Toupet procedures]).  In the rare event that a diaphragmatic hernia is repaired without a lap Nissen, an unlisted laparoscopy [...]

Reader Question: Medicare, Private Carriers Differ on Modifier -50   (August 2001)

Question: When using modifier -50 for a bilateral procedure, should we list the procedure code twice with -50 appended to the code on the first line, or should we only use the procedure code once, with -50 appended? How much should we charge? Michigan Subscriber
 Answer: The answer depends on the payer, says Barbara Cobuzzi, MBA, CPC, CPC-H, a coding and reimbursement specialist and president of Cash Flow Solutions in Lakewood, N.J. For example, most Medicare carriers [...]

Reader Question: Modifier -78 Requires Return to OR   (August 2001)

Question: Please clarify whether modifier -78 can be used only in a hospital. We sometimes perform a procedure in the office, such as an I&D of postoperative seroma, and – a few days later – perform another I&D for the same reason, appending modifier -78. Is this correct?Michigan Subscriber
 Answer: Modifier -78 (return to the operating room for a related procedure during the postoperative period) should be used only if the patient is returned to the operating room [...]

Four Tips to Optimize Billing for Post-burn Grafts and Flaps   (July 2001)

Following treatment, full-thickness burns must be covered to restore the skin barrier, reduce the risk of infection and prevent fluid and electrolyte loss. Covering also reduces scarring – which can restrict range of motion (scar tissue is inflexible and frequently contracts, and is also more easily damaged and burned). 
Typically, the affected area is dbrided and covered, or in some cases closed, using a graft or flap. Coding these services can be challenging because:
 
The size, location and [...]