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Melissa Posted 6 Year(s) ago

I looked at 43840.

SuperCoder Posted 6 Year(s) ago

The Graham patch uses sutures placed on either side of the perforation, lemberted, with the addition of the omentum. The surgeon uses sutures to secure the patch and close the perforation.

CPT contains no specific code to describe Graham patch omentoplasty, and the AMA and most coding experts advise against choosing "the next best" CPT code when reporting procedures without a distinct CPT code. Although you may contact individual carriers for instructions in some circumstances, generally if the service you provide is not included in CPT, the best code choice is an unlisted-procedure code (e.g., 44799, Unlisted procedure, intestine).

Use of the unlisted-procedure code should alert the payer that the claim requires individual attention. Be sure to include complete documentation, explaining the procedure in full, including the time and supplies involved. It may be helpful to compare the surgery to another, similar procedure (e.g., 43840, Gastrorrhaphy, suture of perforated duodenal or gastric ulcer, wound, or injury) to give the payer a "point of reference" to make a payment determination (it may speed payment to put this, along with the title of the operation, in box 19 of the CMS-1500 form). The payer will use this information to determine payment.

Posted by Melissa, 6 Year(s). There are 2 posts. The latest reply is from SuperCoder.

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