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General Surgery Coding Alert

Biopsies:
Dig Deeper to Get More Pay Than 11100 Delivers
Look beyond integumentary codes for specific tissues.A skin biopsy is a skin biopsy is an ... Read more
ICD-10:
173 to C44: Look for Close Malignant Skin Neoplasm Crosswalk
Melanoma and more report to different codes.Not a lot will change once you start reporting... Read more
CPT® 2013:
32420-32422 Are Out -- Prep 4 New Thoracentesis and Drainage Codes
Clear up old aspiration questions with new codes.If your general surgeons provide chest tu... Read more
Medicare Re-Enrollment:
Update Your Revalidation Plan With New CMS Instruction
Kinder, gentler process forestalls 'revocation.' Don't lose your ability t... Read more
Reader Question:
Incomplete TIF Reverts to EGD
Question: Our surgeon performed an EGD with intention to complete a TIF procedure. Here's ... Read more
Reader Question:
Include Fistula in Hernia Repair
Question: Patient was scheduled for open umbilical hernia repair, but fistula tract was al... Read more
Reader Question:
45345 Includes Dilation and Fluoroscopy
Question: Our surgeon performed a sigmoidoscopy with stent placement. During the procedure... Read more
Reader Question:
Bypass 2013 ICD-9 Changes
Question: We always prepare for ICD-9 changes in the fall of each year, but I haven't hear... Read more
You Be the Coder:
Untangle Assistant Surgeon Puzzle
Question: I'd appreciate some help with how to bill for the following scenario for a patie... Read more
CCI 18.3:
12001-13153: Halt Closure Coding with (Almost) Anything
Report repair alone or with lesion excision only.In case you've ever wondered if you could... Read more
ICD-10:
S21.1_ Adds Detail Beyond 876.0 for Back Wounds
Laceration, puncture, and more expand codes. Coding wound closure requires identifying wou... Read more
CPT® 2013:
Make the Most of 'Other Qualified Healthcare Professionals' Billing
Don't limit E/M services to general surgeons in your practice.If you've been losing pay wh... Read more
Vascular Surgery:
36147 Details Hone Your Diagnostic AV Shunt Coding
Distinguish +36148, 75791.If your surgeon performs an arteriovenous (AV) shunt introductio... Read more
Reader Question:
Stick to Diagnostic EGD Code
Question: Our surgeon had performed a gastric bypass for a patient who returned five month... Read more
Reader Question:
Base Debridement Choice on Depth and Size
Question: Our surgeon treated a patient with severe diabetic ulcer on his lower leg. He de... Read more
Reader Question:
Select 'Unspecified' Appendix Code
Question: Our surgeon removed a patient's appendix, and the pathology report returned with... Read more
You Be the Coder:
Multiple Codes Cover Duodenal Ulcer Case
Question: How should we code the following case for an open gastrojejunostomy with vagot... Read more
Gastric Restrictive Procedure:
43770 and Beyond: 3 Tips Promise Proper 'Banding' Code Choice
Learn 'unlisted' tricks for coding gaps. Don't lose pay by choosing the wr... Read more
E/M Reporting:
Grab Value From '95 vs. '97 Guideline Distinction
Physical exam element can point you to the better set.You might boost your evaluation and ... Read more
News Brief:
Get Ready for Medicare Pay Cuts -- Yet Again -- in 2013
Watch for final rule and Congressional changes.There may be some winners and losers this y... Read more
ICD-10:
Add 'Excess Calories' to Obesity Documentation
Don't confuse 'other' with 'unspecified.' Although coding morbid obesity won't tell the wh... Read more
Global Days Restrict Lap-Band Adjustment Pay
Follow payer guidelines for code choice.Can you collect pay when your surgeon uses the sub... Read more
Reader Question:
Details Flesh Out Ileotransverse Bypass Code
Question: Our surgeon performed an intracolonic (ileotransverse) bypass. Instead of removi... Read more
Reader Question:
Modifier, Not Code, May Capture Take-Down
Question: What is appropriate CPT®code for mobilization of splenic flexure in additi... Read more
Reader Question:
Preserving Structures Governs Neck Code Choice
Question: Our surgeon performed an open selective neck dissection, removing cervical lymph... Read more
Reader Question:
Take Care When Billing for Same-Day E/M Visits
Question: We had a patient with a hiatal hernia who saw one surgeon in our practice, and t... Read more
You Be the Coder:
Don't Miss Sentinel Node Service
Question: When our surgeon performs 19301 or 19303, she wants to additionally bill +38900 ... Read more
CCI 18.2:
Rethink Your Hiatal/Diaphragmatic Hernia Coding Boundaries
Pay attention to more specific 'abdominal' CPT® sections, too. Before you consider ... Read more
Look Out for Flood of '0' Modifier Indicators
CCI 18.2 changes 'override' option for many surgical codes. New Correct Coding Initiative... Read more
Upper GI Procedures:
4 Tips Go the Distance For EUS Plus FNA/Biopsy
Your hard-earned $$$ could be on the line. The three codes might not be together in CPT&#... Read more
Regulation:
Supreme Court ACA Ruling -- See What it Means for General Surgeons
You may experience short-term 'preventive care' bonus. Now that the Supreme Court has uph... Read more
ICD-10:
568.0 Crosswalks to K66.0 for Peritoneal Adhesions
Exclusions vary slightly for new diagnosis code set. Unlike many conditions, you won't ne... Read more
Reader Question:
Capture Multiple Scope Procedures
Question: Our surgeon performed a colonoscopy on a patient who had a previous sigmoid col... Read more
Reader Question:
Expect Significant Time for Assistant Surgeon
Question: When we have an assistant surgeon from our practice scheduled to assist the pri... Read more
Reader Question:
Meet Mid-Point Requirement for Moderate Sedation
Question: Should we report 99144 and +99145 when the surgeon documents 36 minutes of mode... Read more
You Be the Coder:
Bone Up on Scar Revision
Question: For a patient requiring revision of a scar on his left leg, our surgeon excised... Read more
Bariatric Surgery:
Answer 4 Questions to Pick the Right Gastric Bypass Code
Centimeters count for some codes. Duodenal switch, Roux-en-Y, limb length ... let us h... Read more
Gastric Bypass:
Don't Count on Obesity for Medical Necessity
Look for co-morbid factors too. If your surgeon wants to get paid for bariatric surger... Read more
ICD-10:
V85 to Z68: Take a Straight BMI Path from ICD-9 to ICD-10
Adult codes still dominate. With all the press on childhood obesity, ICD-10 still prov... Read more
ICD-10 Outlook:
See How AMA and Provider Feedback Impact ICD-10 Delay
Don't let changes catch your surgery practice by surprise.CMS hasn't made a final announce... Read more
E/M Reimbursement:
Don't Forfeit Pay by Choosing 'Safer' Office Visit Code
You might be committing fraud. Have you ever selected a lower-level evaluation and man... Read more
Reader Question:
Modifier 50: Know When "Times 2" Won't Fit the Bill
Question: Our surgeon performed a bilateral mastectomy for a Medicare patient. The right... Read more
Reader Question:
44120: Capture Enterectomy and Anastamosis
Question: Gallstone identified in med-jejunum causing bowel obstruction. Surgeon performed... Read more
Reader Question:
Document E/M Components for Consultation
Question: One of our surgeons was called into a surgery-in-progress to consult on a possib... Read more
Reader Question:
Know When to Apply Anti-Markup Rule
Question: Our surgical group sometimes purchases lab tests from an outside lab and bill Me... Read more
Reader Question:
Convert Laparoscopic to Open Lymphadenectomy Code
Question: For a patient with abdominal lymphadenopathy, our surgeon performed a laparoscop... Read more
You Be the Coder:
Look to Relevant Codes for Payment
Question: Our surgeon treated a patient with an amputated right ear. The surgical procedur... Read more
Breast Case:
Capture Each Step of 2-Phase Case to Boost Breast Surgery Pay
Distinguish lesion excision, lumpectomy. When a patient advances through multiple diagnost... Read more
ICD-10:
D05: Expand Beyond 233.0 for Breast Cancer 'In situ'
Location and type lead code choice.Expect significant changes in how you report in situ br... Read more
Hernia Toolbox:
Chart Your Hernia Location to Narrow Dx and Procedure Code Choices
Zero in on proper code with hernia glossary-of-terms. Reporting hernia repair requires so ... Read more
Billing:
Solve Secondary Payer Woes With Expert Answers
Rules determine who's primary and secondary.If you've ever been confused about submitting ... Read more
Reader Question:
Best Bet: Choose One Graft Code
Question: We have a surgeon who is placing split-thickness skin grafts on burn patients an... Read more
Reader Question:
Use 'Secondary' for Metastatic Cancer
Question: How should we code malignant breast cancer with findings of metastasis to liver ... Read more
Reader Question:
What's the 'Right Way' to Bill Medicare?
Question: As a participating Medicare provider submitting claims to Trailblazer (J4 MAC), ... Read more
You Be the Coder:
46211: Use for All Internal Ligations?
Question: Our surgeon performs internal hemorrhoid ligation using surgical thread. Should ... Read more
CPT® 2012:
5 Tips for Large Tumor Excision Exemplify Skin Replacement Rules
Know when to capture pay for preparation, placement, and more. With new codes and an ... Read more
ICD-10:
172 to C43, D03: Look for 2 Melanoma Families in ICD-10
Watch for more specific site options, too.The ICD-10 implementation delay might give you a... Read more
CCI 18.1 Update:
Skip Selective Catheter Placement with Vessel Repair
Plus, don't mix new compression codes with manipulation.Certain CPT® 2012 codes that... Read more
ICD-10 Delay:
Anticipate 1 Extra Year for Your ICD-10 Implementation Schedule
But don't count on the delay quite yet, expert warns. As part of a proposed rule to adopt ... Read more
Reader Question:
44208 Means Colostomy
Question: Our surgeon performed a laparoscopic low-anterior colon resection with a diver... Read more
Reader Question:
+44955 Requires Appendix Pathology
Question: While performing bariatric surgery (Roux-en-Y), our surgeon also performed an ap... Read more
Reader Question:
Remember 19102 Ancillary Services
Question: The surgeon performs two breast needle core biopsies under fluoroscopic guidance... Read more
Reader Question:
Other Sources May Provide History
Question: One of our surgeons admitted a 72-year-old woman as an initial inpatient. He per... Read more
You Be the Coder:
Distinguish Internal/External Hemorrhoids
Question: Our surgeon treated a patient with two internal hemorrhoids that protruding thro... Read more
Pressure Ulcer:
1104X or 159XX: 4 Tips Focus Decubitus Ulcer Code Selection
Don't miss CPT® 2012 debridement equation. With over 25 CPT® codes and nine IC... Read more
ICD-10:
2-Code Pressure Ulcer Becomes Just 1 for ICD-10
You won't need an additional code for 'stage.' When you report a pressure (decubitus) ulce... Read more
Audits:
Prepare Your Practice for 5 Common Audit Types
Avoid RAC trap for bilateral surgeries.If it seems like audits are coming at your general ... Read more
Enterolysis Coding:
44005 and 44180: Know When to Punt to Modifier 22
Bundling rules restrict separate lysis-of-adhesions coding. When your surgeon cuts thr... Read more
Reader Question:
3 Reasons to Wait for Dx
Question: Is there a hard-and-fast billing rule that requires us to wait for the pathology... Read more
Reader Question:
Check Out This ICD-10 Deadline Change
Question: I've heard that the ICD-10 implementation delay is for one year, but I can't fin... Read more
Reader Question:
49553, 49557: Reserve for Open Procedures
Question: If the surgical note doesn't indicate whether an incarcerated femoral hernia is ... Read more
Reader Question:
Skip HPI and Skip Your EM Pay
Question: A new patient visited our office for evaluation for an umbilical hernia repair. ... Read more
You Be the Coder:
Look to Musculoskeletal Codes for Lipoma
Question: Our surgeon excised a 3.4 cm lipoma in the sacral region. Should I choose a co... Read more
Modifier Quiz:
Test Your 58/78 Know-How With 'Return to Surgery' Scenarios
See how one error can cost your practice plenty. You learned how to choose the appropriate... Read more
ICD-10:
C50 Incorporates 174-175
Male and female breast dx collapse to one family. You're used to choosing codes fr... Read more
Modifier Quiz:
Check Your 58/78 Knowledge With These Scenario Answers
Compare your coding from the quiz on page 25 with our experts' solutions.Read on to see ho... Read more
ICD-10:
You Have More Time to Implement ICD-10, HHS Confirms
Without new date, press on with preparation for your general surgery practice.ICD-10 imple... Read more
Medicare Physician Fee Schedule:
You Won't Face 27 Percent Medicare Cut for 2012
Congressional 10-month delay pushes payment formula problems to 2013.For practices fearing... Read more
Reader Question:
Unravel Consult vs. Observation E/M
Question: Our surgeon was called for a consult while the patient was in observation status... Read more
Reader Question:
Not All Family Earns 'Family History'
Question: Our surgeon performed a screening colonoscopy because the 37-year-old patient's ... Read more
Reader Question:
Too Small for Intermediate Closure
Question: I'm aware of a "rule" regarding lesion excision and closure charges that I am qu... Read more
Reader Question:
Distinguish Non-Selective/Selective Peripheral Vascular Codes
Question: Our practice recently added a surgeon who specializes in peripheral vascular pro... Read more
Reader Question:
38740: Reserve for Separate Surgical Procedure
Question: If the surgeon excises a breast mass from the lower inner quadrant based on a pr... Read more
You Be the Coder:
Second Dilation Yields Reduced Pay
Question: Our surgeon performed an EGD with balloon dilation, followed by a separate EGD... Read more
Correct Coding Guidelines:
CCI Policy Manual Restricts Coverage for Procedure + Imaging
Plus, learn endoscopic and bone marrow limitations. Keeping up with Correct Coding In... Read more
ICD-10:
Tap Z85.038 For Personal History of Colon Cancer
Don't expect code descriptor changes when new system kicks off in 2013.A personal history ... Read more
Modifiers:
3 Tips Distinguish 58 and 78 to Impact Your Bottom Line
Same condition or complication makes the difference.Choosing the appropriate global-period... Read more
HIPAA:
With Audits Heating Up, Is Your Practice Ready?
Make sure your privacy and security practices are up-to-date.If your HIPAA protocols fall ... Read more
Reader Question:
Wait for Oct. 1, 2013 for ICD-10
Question: I'm writing to find out whether many of your subscribers have started billing wi... Read more
Reader Question:
+15777 vs. 49568 Depends on Purpose
Question: Our surgeon repaired an initial incarcerated incisional hernia and closed with a... Read more
Reader Question:
Removal or Ablation Drives Code Choice
Question: As part of a colonoscopy, the surgeon noted internal hemorrhoids, which he ablat... Read more
Reader Question:
569.81 Migrates to K63.2 for ICD-10
Question: What is the correct ICD-9 code for a mucous fistula encountered during a transve... Read more
You Be the Coder:
PT Paves the Way for Diagnostic Colonoscopy Pay
Question: A screening colonoscopy for a patient resulted in a biopsy. The patient has Medi... Read more
CCI 18.0:
15271-+15278 and Beyond: Navigate Edit Pairs to Optimize Pay
Identify standard surgical services to steer through bundle traps. Not one new CPT® ... Read more
Catch Up Your Outpatient Edits to CCI 18.0
Counting on version 17.3 will put you behind.If you're used to ignoring new CCI edits for ... Read more
ICD-10:
Await 6 Renal Tumor Diagnosis Codes in 2013
Right and left will matter under ICD-10.If your surgeon performs renal-artery catheter pla... Read more
News brief:
Expect 2-Month Medicare Payment Reprieve
SGR formula fix is key.You won't face a 27 percent Medicare pay cut beginning Jan. 1 after... Read more
CPT 2012:
37191-37193: Banish Unlisted Codes From Your IVC Filter Claims
Get ready for new renal catheter placement codes, too.Surgical codes that describe the who... Read more
+15777:
Avoid New Biologic Implant Code With Hernia
Save it for fascia support in soft tissue.If your surgeon frequently performs hernia repai... Read more
CPT® 2012:
Capture E/M Billing Opportunity for New Thoracoscopy Codes
Note CMS' surprise 0-day global.Not only did CPT® 2012 change the heading of its "Th... Read more
Reader Question:
Save 'Uncertain' Neoplasm for Specific Diagnosis
Question: When one of our surgeons removes a breast mass, he insists on putting the diagno... Read more
Reader Question:
99241-99255: Keep Consults When Possible
Question: Can we still use "consult" E/M codes?North Carolina SubscriberAnswer: The answer... Read more
Reader Question:
Decide Billing Order for Bilateral Procedures
Question: When billing multiple surgeries, we usually put the procedure with the highest R... Read more
Reader Question:
Note Must Lead Diagnosis Selection
Question: When I bill Medicare for deep debridement (11042) using the diagnosis the surgeo... Read more
You Be the Coder:
Depend on 78 for Bleeding Control Return
Question: Our surgeon performed a colonoscopy with polyp removal 45385, and discharged the... Read more
Physician Fee Schedule 2012:
Brace Your Practice for 27% Medicare Conversion Factor Cut
Plus: Thoracic, integumentary rates on the line. 'Tis the season for another round of tens... Read more
Beware:
Medicare's '3-Day Payment Window' Could Impact Your Practice
Ownership is the key for general surgeons.Did you know that one of the least publicized ch... Read more
CPT® 2012:
You'll Get Closure With New Skin Repair Guidelines
Also, don't miss separate debridement opportunity. Feeling overwhelmed by all the ... Read more
ICD-10:
Get Ready for ICD-10 With These CMS Templates, Planning Assistance
Whether large or small, you'll find guidance for your practice.With less than two years to... Read more
CPT® 2012:
Use Latest E/M Tweaks to Establish New Patient Status
Same practice and specialty no longer preclude new patients.You've faced the dilemma befor... Read more
Reader Question:
Count Time Differently for CPT® vs. CMS
Question: If the physician documents: "Time spent in the evaluation of the patient with mo... Read more
Reader Question:
ICD-10 Prep is Different for Paper Claims
Question: If we file paper claims to Medicare, will the claims form change once we begin u... Read more
Reader Question:
Decide HPI Level Based on Element Number
Question: A patient came to the surgeon's office complaining of severe abdominal pain. The... Read more
Reader Question:
Identify 'Extremity' to Find Correct Code
Question: What is the correct diagnosis code for popliteal artery stenosis?North Carolina ... Read more
You Be the Coder:
Decubitus Ulcer: Look for Closure Documentation and More
Question: Our surgeon performed an ischiectomy during excision of an ischial pressure ul... Read more