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General Surgery Coding Alert

'Lavage' May Be More Than You Think
What to watch to avoid a $500 (or more) mistake If your surgeon must return a patient t... Read more
Look to Underlying Condition When Applying Modifier 58
-More extensive- might not mean what you think When making a decision to apply modifier... Read more
Deep Debridement Has 10-Day Global
A recent General Surgery Coding Alert (vol. 10, no. 10, page 76) stated that deep debridem... Read more
Watch Your Dx. for Liver Bx. Success
Laparoscopic biopsy requires an -unlisted procedure- CPT If you-re having problems gett... Read more
Reader Questions:
Modifier 78 Won't Provide Total Reimbursement
Question: I-ve noticed that when we report procedures with modifier 78, the payer will r... Read more
Watch Location for Unlisted Hernia Repair
Question: Which code should I report for a laparoscopic paraesophageal hernia repair? Th... Read more
Reader Questions:
Look Out for Included Mesh Removal
Question: Which code should I use for the removal by laparotomy of an infected Marlex Du... Read more
Reader Questions:
Report Fluoro Codes With Caution
Question: Under what circumstances may our surgeon code for fluoroscopic guidance provid... Read more
Reader Questions:
Think Twice When Billing X-ray, MRI Interpretations
Question: Can our general surgeons charge for reading x-rays and MRIs taken at an outsid... Read more
You Be the Coder:
When Can You Report Presurgical H&P?
Question: Can we charge for a preoperative visit when the surgeon performs a history and... Read more
Here's Your Wound 'Exploration' Explanation
Extent of repair will help to guide your code choice When your surgeon "explores" a wou... Read more
Modifier 25 Isn't Always the Answer for Same-Day E/M
Keep E/M documentation apart to demonstrate the service's -separate- status To report a... Read more
Relative Value File Gives You Global Information
You can find global periods for all CPT procedure codes by consulting Medicare's National ... Read more
Stick With 47379 for Lap. Liver Bx.
A recent You Be the Coder ("What Code for Lap Liver Bx," General Surgery Coding Alert, vol... Read more
Reader Questions:
Separate Session = Billable Control of Bleeding
Question: I understand that you should include control of bleeding during a surgical pro... Read more
Reader Questions:
Avoid Cat. I Code for Autologous Plasma Grafts
Question: Is there a CPT code for the use of autologous platelet rich plasma grafts that... Read more
Reader Questions:
Follow-Up Thrombectomy Calls for 79
Question: A week following creation of an AV fistula, the surgeon had to perform a throm... Read more
Reader Questions:
Coordinate Documentation for In-Office Referrals
Question: For a patient interested in taking the M2A capsule to diagnose her small-bowel... Read more
Reader Questions:
Select Fifth Digit for Bed Sore Dx.
Question: Recently, we received a denial for debridement of a decubitus ulcer, coded as ... Read more
Reader Questions:
Biopsy Can Be Separate From Mastectomy
Question: If the surgeon performs a breast biopsy, and if frozen section comes back posi... Read more
You Be the Coder:
How Do FNA and Puncture Aspiration Differ?
Question: I-ve always been somewhat confused by the difference between fine needle aspir... Read more
Enterectomy 101:
Use This Step-by-Step Guide to Master Intestinal Resection Coding
Atresia dx provides a quick clue to CPT assignment Reporting resections of the small in... Read more
1 Question Separates Ulcer Excision From Debridement
Closure with muscle flaps provides an additional reimbursement opportunity Knowing woun... Read more
Make the Most of After-Hours Codes:
Here's How
Medicare won't pay, but others may If your surgeon provides a service during "non-tradi... Read more
Reader Questions:
Avoid G-Tube, Endoscopy Unbundle
Question: In the past, we used 43750 for gastrostomy tube placement [CPT deleted 43750 f... Read more
Reader Questions:
CPT Accounts for 'Pill Cams'
Question: What can you tell me about coding for a "gut cam" or "pill cam"? Must I use an... Read more
Reader Questions:
Cholangiogram Isn't Separate With Exploration
Question: If the surgeon performs both cholangiography and exploration of the common bil... Read more
Reader Questions:
Weight, Not Age, Determines 63 Applicability
Question: The surgeon performed an initial repair for a reducible inguinal hernia on a p... Read more
Reader Questions:
Site Prep Is Separate With Most Skin Grafts
Question: Following escharotomy (16035-16036) and debridement (16020-16030) and prior to... Read more
You Be the Coder:
Can Control of Bleeding Be Separate?
Question: When, if ever, may I report control of bleeding as a separate service at the s... Read more
Shave Your Claims Mistakes:
Not Every Removal Is an Excision
Tip: Skip margin calculations for 11300-11313 When reporting shaving of epidermal or de... Read more
Revalidation Requires Your Attention -- Now
Medicare can pull billing privileges for noncompliance All practices billing Medicare s... Read more
Ask 11 Questions to Assess Your Revalidation Compliance
1. Is the provider's Medicare correspondence address on file current and reliable? If not,... Read more
CCI Quick Update:
Unna Boot Faces New Bundles
The latest version of the Correct Coding Initiative (14.1) introduces several new bundling... Read more
News in Brief:
CMS Proposes Big ICD-9 Changes
Proposed changes to ICD-9-CM for 2009 call for the greatest number of revisions in more th... Read more
Reader Questions:
Approach Is Crucial for Fistula Repair
Question: I find two codes in CPT for repair of ileoanal pouch fistula/sinus that differ... Read more
Reader Questions:
Smallest Margin Measurement Matters for Excision
Question: I am confused regarding how to determine lesion size when coding for excisions... Read more
Reader Questions:
Watch for Specifics When Selecting Biopsy Code
Question: Our surgeon performed a diagnostic laparoscopy with biopsy for multiple liver ... Read more
Reader Questions:
Zoom In on 'Targets' Before Coding Sedation
Question: An established 64-year-old patient complaining of rectal pain and abdominal cr... Read more
Reader Questions:
Consider Timing, Location, Intent for Skin Biopsy
Question: How do I know when to report skin biopsy separately with, or in place of, othe... Read more
You Be the Coder:
ICD-9 and CPT Link Closely for Burns
Question: In the emergency department (ED), our surgeon saw a 9-year-old girl with blist... Read more
Vascular Family Matters for Catheter Coding
Not every vessel the surgeon crosses deserves a code Vascular coding basics tell you no... Read more
Master Thoracoscopy Coding in Just 3 Steps
You can report diagnostic scope separately -- in some cases If you follow a few simple ... Read more
Watch How You Sequence and Link Colonoscopy Dx
Don't be thrown by this wrinkle in -screening-turned-diagnostic- coding Recent CMS inst... Read more
New ABN Will Free You From NEMB Confusion
Update now if you-re not already using the revised form If you-ve never quite understoo... Read more
Reader Questions:
Depth and Location Matter Most for Lipomas
Question: Recently, our surgeon excised 18 lipomas from a patient's right arm, and 14 fr... Read more
Reader Questions:
Suture Removal May (Rarely) Be Separate
Question: May we report suture removal separately? California Subscriber Answer: You... Read more
Reader Questions:
Chole With Exploration Includes Cholangiogram
Question: Our surgeon started out doing a laparoscopic cholecystectomy with cholangiogra... Read more
Reader Questions:
Unna Boot Application Includes E/M
Question: Our surgeon recently applied an Unna boot for a patient with decubitus ulcers.... Read more
You Be the Coder:
Can 2 Docs Report 43246?
Question: In our-practice, two surgeons work together to place a percutaneous gastrostom... Read more
Cut to the Facts of Wound Repair:
5 Tips for Foolproof Reporting
Apply modifier 59 for same-location, different-severity repairs Coding for wound repair... Read more
Here's What Wound Repair Includes -- and What It Doesn't
Warning: Separate debridement requires -gross contamination- You will often see wound r... Read more
Meet 3 Requirements for Modifier 22 Success
Provide a comparison to defend additional reimbursement You probably already know that ... Read more
Consider These Circumstances for Modifier 22
"Increased" circumstances that might call for modifier 22 include (but are not limited to)... Read more
Reader Questions:
Excision Includes Same-Site Biopsy -- Usually
Question: My I report a biopsy code in addition to an excision at the same location? Or ... Read more
Reader Questions:
Surgical Service Includes Visualization
Question: Our surgeon performed an exploratory laparoscopy followed by an open cholecyst... Read more
Reader Questions:
Modifier 52 Makes the Case for Bolster Replacement
Question: How should I report replacement of a "mushroom basket" for a PEG tube? I can't... Read more
Reader Questions:
Sigmoidoscopy May Affect Screening Eligibility
Question: In General Surgery Coding Alert Vol. 10, No. 6, pp. 43-46, you advised that Me... Read more
You Be the Coder:
How Can You Report Tube Removal?
Question: A physician in another city placed a laparoscopic jejunostomy tube one month a... Read more
Don't Let Your PEG Coding Go Down the Tubes:
5 Tips You Need Now
G-tube procedures now include fluoroscopic guidance, when used Recent AMA revisions hav... Read more
You Can Report Multiple Endoscopies
If the surgeon performs another endoscopic procedure (for instance, 43239, Upper gastroint... Read more
Once a Screening, Always a Screening, CMS Says
The colonoscopy procedure code may change, but the dx won-t A recent CMS Transmittal ha... Read more
CPT, CMS Differ on Incomplete Colonoscopy
In direct contradiction to CMS guidelines, CPT instructs you, "For an incomplete colonosco... Read more
Patient Age Can Be an Issue for Coverage
Medicare guidelines generally require that a screening exam is a covered benefit for Medic... Read more
Reader Questions:
Takedown Only Separate With Partial Colectomy
Question: May I report takedown of the splenic flexure with a total colectomy (44150)? My ... Read more
Reader Questions:
Count Incisions for Multiple Hernia Repairs
Question: Our surgeon performed a laparoscopic recurrent right inguinal hernia repair, a... Read more
Reader Questions:
CMS Says No-Show Fee Is OK -- Sometimes
Question: What is Medicare's billing policy for missed appointments? Wisconsin Subscrib... Read more
You Be the Coder:
Can Chole Be Separate With Whipple?
Question: Can we report a cholecystectomy at the same time as a whipple procedure if the r... Read more
Identify Every Billable Element to Ace Your Colectomy Claims
Mobilization of splenic flexure calls for add-on code Not all partial colectomy procedu... Read more
Part 2:
4 More Ways to Revive Your ED E/M Coding
Without a separate dx, you won't report ED and other E/M service together You already k... Read more
Don't Use Open Appendectomy Add-On With Laparoscopic Procedure
When reporting laparoscopic procedures, you should never use a code that describes an open... Read more
Reader Questions:
Treat Same Tax ID as Same Doctor
Question: There are six surgeons in our practice, all billing under the same tax identif... Read more
Reader Questions:
Re-Intubation Code Depends on Time, Location
Question: A patient underwent tracheostomy one week ago. A week later, the physician had... Read more
Reader Questions:
Allograft, Xenograft Re-Application Coding Differ
Question: Previously, General Surgery Coding Alert recommended reporting allograft codes... Read more
Reader Questions:
Watch for Separate Cholangiography, Chole
Question: Which is the correct code to describe "radiologic examination of the bile duct... Read more
Reader Questions:
Pay Attention to Approach for Pouch Repair
Question: How should I code repair of an ileoanal pouch fistula? New Mexico Subscriber ... Read more
Reader Questions:
Gastric Aspiration Calls for 91105
Question: Our surgeon saw a patient complaining of rectal bleeding in the emergency depa... Read more
You Be the Coder:
Is Lipoma Excision Separate With Hernia Repair?
Question: During an inguinal hernia repair (49505) with mesh, the surgeon performs an ex... Read more
Master Terminology for Whip-Smart Whipple Claims
Knowing if the surgeon joined the jejunum and pancreatic duct cuts your code selection i... Read more
CPT 2008:
Modify Your Modifier Practices: Here's Why
The AMA works harder to convince you of documentation's importance If you-ve been less ... Read more
CCI Update:
Increased Edit Pressure for Recto/Anal Surgeries
Wound repairs also face new bundles, but confirm what you-re already doing Version 13.... Read more
CMS Expands Medically Unlikely Edits for the New Year
A new modifier may be required for -unlikely- procedures The controversial medically un... Read more
CMS Paves the Way for Expanded Sedation Coverage
-Minimal- and -moderate- aren't the same, so check documentation carefully CMS has give... Read more
Reader Questions:
If Cancer Is Verified, It's Not a Screening
Question: The surgeon performed colonoscopy "to examine the remainder of the colon" on a... Read more
Reader Questions:
History Begins When Active Treatment Ends
Question: If a patient has been diagnosed with cancer, does a "history of cancer" diagno... Read more
Reader Questions:
Medical Necessity Always Drives E/M Level
Question: I-m not clear on what CPT intends when it states I may report a given E/M leve... Read more
Reader Questions:
Wound Culture Offers Many Options
Question: How should I bill for a wound culture? My physician may be seeing a patient po... Read more
You Be the Coder:
What Code for Lap Liver Bx?
Questions: The surgeon performed a laparoscopic cholecystectomy-and a liver biopsy at th... Read more
Refined Descriptor Language and New Vascular Codes Top CPT 2008 Changes
G-tube procedure codes also undergo extensive revisions While numerous small tweaks and a... Read more
Bariatrics Overhaul Won't Affect Code Use
New language in several bariatrics surgery code descriptors won't affect how you-ll appl... Read more
Don't Overlook These 4 'Tube' Changes
1. Beginning in January, you will use 49446 (Conversion of gastrostomy tube to gastro-jeju... Read more
CPT 2008:
All the E/M Changes You Need to Know
Rumored -e-visit- code arrives When you open your CPT 2008 manual, you-ll be confronted... Read more
Nursing Facility Services Add Reference Times
CPT 2008 will add reference times to several E/M code categories that did not previously... Read more
Watch for 5 More E/M Changes
Of the five remaining new E/M codes in CPT 2008, two (99406 and 99407) will deal with coun... Read more
Reader Questions:
Every Admission May Bring an Inpatient Consult
Question: My surgeon consulted with a patient for abdominal pain, and he diagnosed chole... Read more
Reader Questions:
Find Your Coding Oasis in 15430
Question: How should I report wound preparation with debridement of eschar when the surg... Read more
You Be the Coder:
How Many ICD-9s for Multiple Burns?
Question: Our surgeon saw a patient for two burns: a second-degree burn on her right wri... Read more
5 Q&A's Bolster Your Suture-Removal Savvy
HCPCS code may be just the thing for private payers If you-re not reporting your physic... Read more
Part 1:
Revive Your ED E/M Coding, STAT
You can report an ED visit and critical care, with modifier 25 Many coders are unaware ... Read more
Could CPT 2008 Finally Soothe Mesh-Removal Blues?
A Category I code for e-visits is scheduled to debut Early information suggests signifi... Read more
Reader Question:
Internal Excision = 'Any Method'
Question: What code is appropriate if the surgeon removes internal hemorrhoids by excisi... Read more
Reader Question:
'Team Conference' Isn't Separately Reportable
Question: Recently, our surgeon and several other specialists met for an hour to discuss... Read more
Reader Question:
Appendectomy Can Be Separate With Disease
Question: Our surgeon performed a laparoscopic cholecystectomy and, while there, directe... Read more
Reader Question:
Expect Consult Confusion to Continue
Question: Has CMS sorted out the difference between a consult and a transfer of care? Wi... Read more
You Be the Coder:
What's the Code for PEG Removal?
Question: Which code should I use for a PEG tube removal in the office? Should I use a f... Read more
That Re-Excision Could Be a Mastectomy:
Here's How to Tell
Append 58 for additional procedures during global period Surgeons will sometimes retu... Read more
Modifier 59 Made Easy:
Look for Separate Location/Session
Be sure to check CCI for a -1- modifier indicator -- or face denials Watch out: Paye... Read more
Grab an Extra $120 With Gall Bladder Removal
Watch for routine services and count the extra reimbursement When your general surgeo... Read more
Reader Question:
Dermabond and Fibrin Aren't Interchangeable
Question: If the surgeon repairs an anal fistula with Dermabond instead of fibrin, can... Read more
Reader Question:
'Major' Global Begins 1 Day Prior to Procedure
Question: Our surgeon provided a consultation to evaluate a patient for acute right-up... Read more
Reader Question:
Unrelated E/M During Post-Op Period Calls for 24
Question: I know to use modifier 78 for a return to the operating room for a post-op i... Read more
Reader Question:
Insertion Depth Determines Lower GI Scope
Question: How can I quickly determine which lower gastrointestinal endoscopy code set I ... Read more
You Be the Coder:
Is Node Biopsy Separate With Mastectomy?
Question: May we report sentinel node biopsy separately with a partial mastectomy, or is... Read more