Reader Question: Know GC Rules for Resident Surgical Assists   (November 2011)

Question: When a resident assists a surgeon in a teaching hospital, do we need to add modifier GC to the procedure code for surgery or is that a modifier for E/M codes only?Florida SubscriberAnswer: Yes, you should append modifier GC (This service has been performed in part by a resident under the direction of a teaching physician) to surgical procedure codes when a resident assists a surgeon in a teaching hospital.Modifier GC is not only [...]

Reader Question: 10021/21011 Bundles Limit Coding   (November 2011)

Question: Our surgeon performed a fine needle aspiration followed by an excision of a 1.5 cm soft tissue mass of the face. Can we bill both the 10021 and the 21011 services? Utah SubscriberAnswer: No, you should not bill 10021 (Fine needle aspiration; without imaging guidance) and 21011 (Excision, tumor, soft tissue of face or scalp, subcutaneous; less than 2 cm) for the two procedures directed at the same mass. Instead, you should report only [...]

Reader Question: Use Inclusive Code for Whipple Resection   (November 2011)

Question: Our surgeon performed a “Whipple Resection,” which included creating an opening between the pancreas and jejunum. How should we code the procedure?California SubscriberAnswer: A complete op note would be necessary to answer this question with certainty, but the best code for the procedure you describe is likely 48150 (Pancreatectomy, proximal subtotal with total duodenectomyh, partial gastrectomy, choledochoenterostomy and gastrojejunostomy [Whipple-type procedure]; with pancreatojejunostomy). The alternate code for the complex Whipple resection is 48152 (… [...]

CCI Edits: 44950, 44970 Appendectomies Catch More Restrictions Under CCI 17.3   (October 2011)

Plus: CMS reverses some venipuncture and catheter placement edits. Your general surgeon may remove a patient’s appendix during another laparoscopic or open abdominal surgery – but don’t expect payment for the appendectomy, thanks to new edit pairs in the latest Correct Coding Initiative (CCI) update. CCI version 17.3, which takes effect Oct. 1, offers 1,380 new edit pairs and 835 terminated bundles, according to an analysis by Frank Cohen, MPA, MBB, principal and senior analyst with [...]

ICD-10: 5 K38 ICD-10 Codes Expand ICD-9 Appendicitis Specificity   (October 2011)

Some conditions gets one-to-one crosswalk.When your surgeon removes an appendix, you’ll have more specific diagnosis code choices under ICD-10, effective Oct. 1, 2013.Distinguish ‘Other’ and ‘Unspecified’Coding for acute appendicitis will change as follows, from ICD-9 to ICD-10:540.0 – Acute appendicitis with generalized peritonitis becomes K35.2 with an identical definition540.1 – Acute appendicitis with peritoneal abscess becomes K35.3 (Acute appendicitis with localized peritonitis)540.9 – Acute appendicitis without peritonitis leads to two possible ICD-10 codes: K35.80 (Unspecified acute appendicitis) or [...]

CPT® 2011 Errata: 47490 Modification Shakes Up Your Cholecystostomy Coding   (October 2011)

Pull out the red pen to correct a dangerous error in your manual.With a 2011 code revision, 47490 joined the ranks of “complete” surgical codes – meaning the encounter requires just one code to represent the procedure and related radiology services. Read on for important information on why CPT revised this code and how you’re expected to use it.See What Updated 47490 Includes to Earn $365CPT 2011 revised 47490 so that it now represents the “complete” [...]

ICD-10: Do This When DOS Spans ICD-9/ICD-10 Implementation Date   (October 2011)

Distinguish “from” and “through” dates.You know you’ll need to start using ICD-10 diagnosis codes for services provided on or after Oct. 1, 2013 – but what about claims for services that begin prior to Oct. 1 and end on or after that date?Example: The general surgeon begins trauma surgery at 10 p.m. on Sept. 30, 2013 and completes the procedures at 1:30 a.m. on Oct. 1, 2013. That means the date of service (DOS) spans the [...]

Co-Surgery: ‘Unlisted Laparoscopy’ Allow Co-Surgeons, Thanks to Fee Schedule Change   (October 2011)

Don’t forget the modifier for distinct services.You’ll no longer have to forfeit pay when your surgeon performs a distinct part of certain laparoscopic procedures with another surgeon, thanks to several recent Medicare Physician Fee Schedule changes. CMS recently offered the good news for several co-surgery codes in Transmittal 2276, with an Oct. 3, 2011 implementation date.Look for Potential Co-Surgery Payment for These CodesCMS will change the co-surgery indicator for spleen surgery code 38129 (Unlisted laparoscopy [...]

You Be the Coder: Define Partial Colectomy Procedure by Reconnection   (October 2011)

Question: What defines a low-pelvic anastomosis as opposed to a partial colectomy – is it the coloproctostomy hook-up or the location below the peritoneal reflection that distinguishes the two?Ohio SubscriberAnswer: Partial colectomy describes the surgical removal of a colon section. The surgeon can reconnect the end(s) of the resected bowel in various ways, one of which is a coloproctostomy. Another name for coloproctostomy is “low-pelvic anastomosis,” which involves suturing the resected end of the colon to [...]

Reader Question: 44202 Hinges on Medical Necessity   (October 2011)

Question: Our surgeon performed a complex repair for a recurrent ventral hernia that involved taking down dense adhesions and removing old mesh. In the process, the op note describes three enterotomies resulting in a small bowel resection. Which services are separately billable?Texas SubscriberAnswer: Selecting the proper code for the hernia repair requires some information you don’t provide. In addition to what you do state – recurrent ventral hernia – you also need the following data:Is it reducible? [...]