Cristina Posted Wed 04th of December, 2019 16:12:00 PM
Newborn has gastroschisis physician tries to reduce the herniated contents but they are too large and so a silo is used to create a patch. Daily the physician reduces the silo until the contents are able to be reduced into the abdominal cavity and the umbilicus is reconstructed and defect closed. What CPT codes do i use for this surgery? i believe there should be 1 code for the primary reduction then the daily reductions of silo and final closure. Help me out. thank you
SuperCoder Answered Thu 05th of December, 2019 07:38:08 AM
Thank you for your question.
Gastroschisis is a type of hernia that is a congenital defect of the abdominal wall in which the abdominal organs are external and do not have any covering.
As per the above documentation, the appropriate code for Gastroschisis repair will be CPT® code 49605 (Repair of large omphalocele or gastroschisis; with or without prosthesis for the initial part of the staged procedure (Silo placement). Hence, report the service with CPT® code 49605-58 (for staged procedure).
For final reduction, removal of silo and closure with repair of abdominal wall defect, report CPT® code 49606-58 (staged procedure).
Also, per CCI edit, there is a bundling conflict between both the codes; therefore, append modifier-59 along with CPT® 49605.
Hope that helps!
Cristina Posted Thu 05th of December, 2019 09:12:14 AM
How do i code the daily reductions done by our physicians? Our physicians see the patient every day and do a daily reduction until the contents are able to be reduced into the abdominal cavity. Also, if they have to recreate the umbilicus can we bill CPT CODE 14000? THANK YOU
SuperCoder Answered Fri 06th of December, 2019 03:03:11 AM
Thank you for your additional query.
Both CPT® codes (49605 and 49606) have a global period of 090 days, so daily reduction of the contents will be considered the part of the procedure within the global period. Also, CPT® code 49606 includes the reconstruction of umbilicus. Reporting CPT® code 14000 additionally for recreation of umbilicus will not be appropriate.
Hope that helps!