Reader Question: Does Friction Count as a ‘Burn’?   (October 2011)

Question: A patient presented with multiple friction “burns” from a treadmill. He had partial thickness friction burns to one hand, both ankles, and one foot. He had a full thickness friction burn down to the fascia on two fingers. Our surgeon cleaned all burns with Shur-Clens® and debrided the loose skin, applied Silvadene®, and applied gauze and dressings to all burn areas. What codes should we report – should we use burn codes?Maine SubscriberAnswer: ICD-9 does [...]

Reader Question: Span Body Site — Not CPT® Code   (October 2011)

Question: Our surgeon excised a very large lipoma located primarily in the upper back, but extending into the right shoulder area. Which anatomic site should I use for coding the service, or should I code a lipoma excision for each site?Missouri SubscriberAnswer: You should not code two lipoma excisions for the example you give. When an excision spans anatomic sites described by different codes, report the code that identifies the site that encompasses the majority [...]

Reader Question: Established Patients Last 3 Years   (October 2011)

Question: We saw a patient over a year ago for a hemorrhoidectomy, and now the patient came back with extreme lower right quadrant pain and our surgeon performed an appendectomy. Should we  bill the appendectomy as a new patient since he’s coming back for a different reason? Idaho Subscriber Answer:  No, you should not bill this case as a new patient. You should bill this as an established patient for several reasons. If your surgeon [...]

Reader Question: Re-Excision Depends on Timing   (October 2011)

Question:  The surgeon performs a lesion re-excision for margin removal because the pathology report identifies “suspicious cells” but doesn’t diagnose malignancy. How should we code the re-excision procedure? Arkansas Subscriber Answer: Coding the re-excision does not depend on the pathology report – whether malignant or benign. The rules for reporting a re-excision procedure depend on whether the surgeon performs the service during the same operative session as the initial excision, or at a later time. For [...]

Skin Replacement/Substitutes: 15002-+15431 Revealed: Revised CPT® Instruction Clarifies Coding   (September 2011)

No fixation means no separate service. The codes and rules for reporting skin replacement and skin substitutes aren’t new, but they’re certainly clearer since CPT® 2011 added two new introductory sections. Let our experts help you navigate the CPT® instructions to learn when and how to accurately report skin replacement and skin substitute grafts. Know When Not to Use These Codes You’ll find over 50 codes that describe various surgical steps and types of skin [...]

Clip and Save: Simplify Graft Coding With This Handy Organizational Chart   (September 2011)

Source defines code families.CPT provides over 50 codes for surgical fixation of skin replacement and skin substitute grafts. Add the following table and “terminology translator” to your coding tool box to help you pick the right code(s).Terminology translator: To understand the “Graft Type” column in the table, you’ll need to use the following glossary:Autograft: Graft using skin taken from the patient’s own bodyAllograft or Homograft: Graft using human skin taken from a donor other than [...]

ICD-10: 728.86 to M72.6: Expect Direct Crosswalk for Necrotizing Fasciitis   (September 2011)

Continue to add additional microorganism code.Converting your necrotizing fasciitis coding from ICD-9 to ICD-10 shouldn’t be too complicated, barring ICD-10 changes before its implementation on Oct. 1, 2013. The two diagnosis coding systems provide a one-to-one crosswalk, as follows:ICD-9: 728.86 – Necrotizing fasciitisICD-10: M72.6 – Necrotizing fasciitis.Even the instruction to use an additional code to identify the infectious (causative) organism aligns from ICD-9 to ICD- 10, making your job that much easier.Organism Codes VaryOnce you get to [...]

ICD-10 Countdown: Get Ready or Get Fined — That’s the CMS Message   (September 2011)

Explore 6 FAQs to ramp up your ICD-10 coding know-how.Denials aren’t the only thing you have to fear if your practice doesn’t implement ICD-10 by the Oct. 1, 2013 deadline. You could face fines, too, according to CMS. Based on comments from CMS representatives in recent CMS ICD-10 teleconferences, we’ve broken down six FAQs that promise to help you ramp up ICD-10 coding for your general surgery practice.Prepare for Medicare and Other PayersCMS has no [...]

You Be the Coder: Remember Distal Vessel for Selective Catheterization   (September 2011)

Question: Please help with coding for the following scenario:Surgeon entered the left brachial artery using a needle and Seldinger technique under fluoroscopic guidance, and catheterized the aortic arch and distally to each iliac and femoral artery. Performed arteriography using contrast, then de-catheterized, applying pressure on the brachial artery. Delaware SubscriberAnswer: The correct code is 36246 (Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family), because [...]

Reader Question: 45380 vs. 45383 Hinges on Documentation   (September 2011)

Question: We have general surgeons at our office who perform many colonoscopies. We’re uncertain about the word “ablation,” which our medical dictionary defines as “removal of a part, as by incision.” Does this mean we can use 45383 for polyp removal by cold biopsy, which would involve sending a specimen to pathology?Michigan SubscriberAnswer: Although you might possibly use 45383 (Colonoscopy, flexible; with ablation of tumor[s], polyp[s], or other lesion[s] not amenable to removal by hot [...]