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General Surgery Coding Alert

Everything You Need to Kick Up Your Unna Boot Reimbursement
You should report same-day debridements separatelyReporting 29580 for Unna boot applicatio... Read more
NCCI Quick Update:
Nix Mesh Placement for Many Hernia Repairs
Modifiers can't save you from these bundling editsYou can forget about separate reimbursem... Read more
3 Field-Tested Ways to Ease Your Modifier 25 Claims
Hint: You can use the same diagnosis to justify an E/M and a procedureThe AMA will pr... Read more
Here's How to Keep Your E/M Modifiers Straight
Assign 57, not 25, for E/M prior to a major surgical procedureIf your surgeon provides an ... Read more
The Ins & Outs of Gastric Bypass
Presented by Jan Rasmssen, CPC, ACS-GI, ACS-OBBariatric surgery, gastric restrictive proce... Read more
READER QUESTIONS:
Count Incisions for Biopsy Coding
Question: What are the rules for reporting multiple sentinel node biopsies?California Subs... Read more
READER QUESTIONS:
Billing for Suture Removal Means Anesthesia
Question: Recently, we experienced circumstances (a severely mentally handicapped patient)... Read more
READER QUESTIONS:
Mesh Removal Code Isn't for Hernia
Question: We hoped that we would be able to report 11008 to describe mesh removal during h... Read more
READER QUESTIONS:
Selective Debridement Pay Is Unlikely
Question: Can our in-office nursing staff report 97597-97598 for selective debridement? I-... Read more
You Be the Coder:
Cholangiography With Exploration--Get It Right
Question: My surgeon performed a lap chole with both cholangiography and exploration of th... Read more
Wound Repair With Lesion Excision? Here's What You Must Know Before You Code
Add together repair lengths for similar wounds Lesion excision includes simple closur... Read more
Surefire Tips for Identifying Wound Repair Level
To identify the level of wound repair, look to the operative report for these key words an... Read more
Case Study:
Clear Away Your Excision Coding Confusion
Append modifier 58 for OR re-excisions during global periodCoding all services involved in... Read more
Clip and Save:
Excision/Wound Repair Quick-Reference Chart
If you-re looking for a easy way to decide if you should report a separate wound repair co... Read more
CPT Consolidates Consult Coding for 2006
'Second opinions' become just another E/M serviceYou-ll have fewer choices to make when re... Read more
READER QUESTIONS:
Expect Reduced Payment for Multiple Endoscopes
Question: How can I report colonoscopy with snare polypectomy at the cecum and biopsy at t... Read more
READER QUESTIONS:
You Can Get Paid for Disability Assessment
Question: I have a patient who is applying for early disability retirement. I have spent f... Read more
READER QUESTIONS:
Never Pass Up a Legitimate Consult
Question: The hospital asked my on-call surgeon to admit a patient. He spent one hour with... Read more
READER QUESTIONS:
Report Either I & D or Excision
Question: A patient had an existing diagnosis of sebaceous cyst, benign, in cheek. The doc... Read more
READER QUESTIONS:
Here's How to Establish 'High Risk'
Question: Which ICD-9 codes prove medical necessity for Medicare's high-risk colorectal ca... Read more
READER QUESTIONS:
Look to 10021-10022 for Fluid Sampling
Question: The surgeon performs fine needle aspiration (FNA) of a peritonsillar abscess. Co... Read more
READER QUESTIONS:
Call on G Code for Dermabond
Question: Which code should I use to report Dermabond? I know the status indicator for G01... Read more
You Be the Coder:
Can You Code for Surgical Dressings?
Question: Can our practice be reimbursed for the surgical dressing (supplies) of a partial... Read more
Lesion Excisions Done Right:
Measure First, Diagnose Later
Warning: Length of incision doesn't equal excised diameter When coding lesion exc... Read more
Keep 4 Facts Straight for Easy Inpatient Consult Coding
In 2006, you'll assign 99231-99233 for all hospital follow-ups When reporting inpatient c... Read more
If You're Billing Consults, Be Sure to Document These 3 Points
Before you even consider reporting any consult service 99241-99263, you must meet (and doc... Read more
Hospital Discharge Pitfalls:
Here's How to Avoid Them
Only one physician can report the discharge service You should always include hospital... Read more
Reader Questions:
Unlisted Procedure Is the Choice for Tube Change
Question: How can I code and get paid for a jejunostomy tube change? Someone suggested 437... Read more
Reader Questions:
Nonphysician Staff Can Perform History Element
Question: Must the surgeon take a patient's history, or can a nurse or other nonphysician ... Read more
Reader Questions:
You Supply Evidence for Unlisted-Procedure Pay
Question: How do insurers determine reimbursement when I report an unlisted-procedure code... Read more
Reader Questions:
Choose Wound Repair Codes for Scar Revision
Question: What is the proper code to report scar revision on a mastectomy site?Louisiana S... Read more
Reader Questions:
'Separate Procedures' Means Bundled Billing
Question: Recently, I filed a claim for 43830, 44005 and 44015. Medicare reimbursed us onl... Read more
Reader Questions:
Gastric Bypass Won't Change EGD Coding
Question: How should I bill an endoscopy for a patient who has had a gastric bypass proced... Read more
Reader Questions:
Type of Graft Determines AV Fistula Code
Question: Which code should I use for creating an AV fistula for vascular access?Hawaii Su... Read more
You Be the Coder:
ED Service or Not?
Question: The hospital asked my on-call surgeon to admit a patient. He spent one hour with... Read more
Here's How to Check Your Breast Biopsy Coding Success
Needle size can help you make the choice between aspiration and biopsyCoding a breast biop... Read more
Puncture Aspiration Differs From FNA
When the surgeon performs a puncture aspiration to destroy a breast cyst, he inserts a nee... Read more
Use Caution for Same-Day FNA and PNB
Turn to modifier 59 for aspiration and biopsy at separate locationsIf the patient undergoe... Read more
Learn From More Examples With This Breast Biopsy Self-Quiz
To be sure that you've mastered breast biopsy coding, test your knowledge against the foll... Read more
Add $25 to Your Hospital Dicharge Claims
If your physicians aren't noting the time spent on discharges, your practice is losing out... Read more
Proven Ways to Optimize Reimbursement with Modifiers
The following supplement to General Surgery Coding Alert is the transcript of a teleconfer... Read more
READER QUESTIONS:
There's No Modifier for Incident-to
Question: Should I use a modifier when reporting services provided incident-to the surgeon... Read more
READER QUESTIONS:
'3-Year Rule' Applies to Practice,Not Physician
Question: A patient sees a surgeon in our group practice. Over two years later, the patien... Read more
READER QUESTIONS:
Insurers Won't Pay for Family Counseling
Question: Is there any way we can charge for a visit to discuss a patient's situation if t... Read more
READER QUESTIONS:
Big Needle Equals Incision
Question: The surgeon removed a fishhook by inserting an 18-gauge needle into the puncture... Read more
READER QUESTIONS:
Supplies Are Included in GI Procedures
Question: One of our surgeons recently asked if we can charge separately for brushes used ... Read more
READER QUESTIONS:
Mark India Ink on Claim With 45381
Question: While the surgeon was performing a colonoscopy on a patient, he noticed a lesion... Read more
READER QUESTIONS:
22 is an Option for Difficult Lap Chole
Question: During laparoscopic cholecystectomy, the surgeon encountered extensive adhesions... Read more
You Be the Coder:
What's the Choice for Lap Ventral Hernia?
Question: Using a laparoscope, the surgeon repaired an incarcerated ventral hernia with im... Read more
4 Rules to Follow to Make the Best of Breast Procedures
'Lumpectomy' is a general term, so proceed with caution when choosing excision/mastectomy ... Read more
Don't Confuse Excision and Biopsy
Keep in mind that a tissue biopsy as described by 19100-19103 is distinct from excision 19... Read more
Sentinel Node Biopsy and Lymphadenectomy Differ
More and more frequently, surgeons are forgoing lymph node excision (38745 by itself or 19... Read more
Coming This October:
ICD-9 Takes Gastric Bypass Seriously
More complete diagnoses could open the door to wider coverage Surgeons performing gastric... Read more
V Codes Make Documenting BMI a Snap
Keep this list handy for easy reference Beginning Oct. 1, you'll be able to report bo... Read more
Prepare Now for Upcoming ICD-9 Revisions
V codes provide greater specificity for family and personal history of disease The May 4 ... Read more
Coding Update:
Refined Fee Schedule Eases, Expands Billing Opportunities
Revisions to the Physician fee schedule Database will have an immediate effect on how you ... Read more
Reader Questions:
Separate Incision May Allow for Hernia Reimbursement
Question: The surgeon performed diagnostic laparoscopy with lysis of adhesions, followed b... Read more
Reader Questions:
Learn Key Phrases for Wound Code
Question: The physician documented a 2.2-cm superficial wound on the forearm that primaril... Read more
Reader Questions:
Scope Type Affects Endoscopy Coding
Question: Last week, a patient presented with diarrhea and anemia. The surgeon performed... Read more
Reader Questions:
Don't Get Burned With Simple Burn Coding
Question: A patient came in with first- and second-degree burns on her hand. The surgeon c... Read more
Reader Questions:
Educational Materials Are a Courtesy
Question: Is there a way we can offset the cost of educational materials, pamphlets, etc.,... Read more
Reader Questions:
36415 Now Describes Venipuncture
Question: How should I report routine venipuncture to Medicare?California Subscriber Answ... Read more
You Be the Coder:
What Makes Obesity 'Morbid'?
Question: What distinguishes "obesity" from "morbid obesity"? Which of these diagnoses sho... Read more
3 Examples Demonstrate When to Add Wound Lengths for Laceration Repairs
Heavily contaminated wounds could lead to an upcode from simple to intermediate repair Wh... Read more
News in Brief:
CMS Changes 'Incident-To' Guidelines - Again
Assume that ordering and supervising physician must be the same person Recent CMS "clarif... Read more
Relationship to Original Procedure Matters for -78, -79
You need a return to the OR to apply -78 When attempting to decide between modifiers -78 ... Read more
2 More Ways the Fee Schedule Database Can Ease Your Coding
Look to 'column X' to improve endoscope claims If you're wondering whether a particular s... Read more
9 Proven Solutions Guarantee Breast Surgery Pay-Up
Presented by Kim Garner, CPC, CCS-P, CHCC The following supplement to General Surgery ... Read more
Reader Questions:
Payers Treat Group Practices as 1 Provider
Question: If surgeon 2 in our group practice provides post-op care for a patient whom surg... Read more
Reader Questions:
Observation Status Is Outpatient
Question: When providing a consult for a patient admitted to observation, should we report... Read more
Reader Questions:
2 Cysts Means 2 Removal Codes
Question: The surgeon excised two sebaceous cysts off of the patient's back. One cyst was ... Read more
Reader Questions:
Written Consult Request Isn't Mandatory
Question: We've heard conflicting information about the requirement for a written request ... Read more
Reader Questions:
Global Determines Postprocedure Coding
Question: Following surgery, we had to readmit a Medicare patient for a wound abscess. Can... Read more
Reader Questions:
If Surgeon Causes Bleeding, He Must Stop It for Free
Question: Our surgeon removed three polyps using hot biopsy forceps during a proctosigmoid... Read more
You Be the Coder:
What's the Code for 'Gut Cam'?
Question: Our surgeon provided gastrointestinal tract imaging with a "gut camera." We have... Read more
Process of Elimination Helps You to Find the Proper Catheter and Line Placement Code
Pay attention to procedure description, not brand names, when identifying venous access de... Read more
Know the CVA Placement Codes
CPT contains 13 codes to describe placement of central venous access (CVA) devices: 36555... Read more
Make Your Venous Access Coding Easy With This Chart
If you're looking for a simple way to choose the appropriate venous access device placemen... Read more
Use Guidance to Recoup Additional Pay With CVAs
Apply modifier -26 for services in a facility settingYou can report imaging services using... Read more
3 Ways to Make the Most of the Fee Schedule Database
Proper modifier use, RVU information and more are just a download awayIf you are looking f... Read more
Easy Instructions to Download The Fee Schedule Database
To download the Physician fee schedule Database, go to www.cms.hhs.gov/physicians/pfs/defa... Read more
READER QUESTIONS:
Choose Wound Code by Body Surface Percentage
Question: The surgeon debrided two sites with infected decubiti. Should I report each site... Read more
READER QUESTIONS:
Stick With POS 21 for Inpatient
Question: We rushed a patient into surgery from the emergency department. The surgeon admi... Read more
You Be the Coder:
When Is -77 Appropriate?
Question: One of our surgeons performed a hemorrhoidectomy for a patient in 2001. Another ... Read more
Diagnostic and Screening Colonoscopies Call for Different Coding Strategies
V code diagnoses provide justification for screening examsWhen choosing a code for a scree... Read more
Yes, You Can Bill Multiple Thoracoscopies
Medicare requires you to bundle 'converted' scopes to open proceduresMost general surgery ... Read more
Limit Size-Based Debridement To Nonphysician Staff
Incorrect 97597-97598 claims could mean up to $250 lessFor your surgeon's debridement serv... Read more
News In Brief:
AMA May Develop Its Own Correct Coding Initiative
Surgery coders may soon face an additional layer of guidelines, because the AMA, which ove... Read more
Medicare Proposes, Rescinds 'Medically Unbelievable' Edits
If you've heard rumors of a new category of coding edits, you can take a deep breath and r... Read more
READER QUESTIONS:
Decompression Bundled to Colonoscopy Code
Question: A patient presented with a pseudo-obstruction in the colon. The surgeon placed a... Read more
READER QUESTIONS:
Don't Bundle Wedge Biopsy of Liver
Question: The surgeon performed an exploratory laparotomy and wedge biopsy of the liver. S... Read more
READER QUESTIONS:
Payers Treat Group Practices as 1 Provider
Question: If Surgeon 2 in our group practice provides post-op care for a patient whom Surg... Read more
READER QUESTIONS:
Exploration Affects Secondary Closure
Question: On several occasions, our surgeons have performed bowel surgery and have had to ... Read more
READER QUESTIONS:
Excision Codes Still Count for Stoma Site
Question: How should I report excision of a skin lesion at the stoma site?Oklahoma Subscri... Read more
READER QUESTIONS:
Previous Hospital Care May Affect E/M Reporting
Question: A provider insurance representative recommended at an in-house seminar that if o... Read more
READER QUESTIONS:
Use Soft Tissue Code for Post-Mastectomy Excision
Question: How can we code for a patient who has already had a mastectomy due to breast can... Read more
READER QUESTIONS:
Depth Determines Lymphadenectomy Code
Question: Which code properly describes axillary lymphadenectomy?Virginia Subscriber Answ... Read more
You Be the Coder:
How Many Hemorrhoids?
Question: Can I report one unit of 46221 for each hemorrhoid the surgeon removes using sim... Read more
Take the Hurt Out of Tonsillectomy Coding in Just 3 Steps
Postsurgery control of bleeding may call for its own code When reporting tonsillectomy, y... Read more
News You Can Use:
VAC Codes and Stretta Face No-Pay Status
Some payers also waver on virtual colonoscopy pay If you're planning to report new-for-20... Read more
Clip-and-Save Tool:
Add Your Way to Easy Tonsillectomy/Adenoidectomy Coding
Here's a quick way to select the correct tonsillectomy and/or adenoidectomy code: Check ea... Read more
Don't Forget the -57 Option for Same-Day E/M Services
Stick with -25 for evaluations with less-intensive services If your general surgeon provi... Read more
Correction:
Separate Wounds Call for Separate Codes
The February 2005 edition of General Surgery Coding Alert contained an error on page 12 ("... Read more
Reader Questions:
Appeal Rejected Claim With 140-cm 'Limb'
Questions: Recently, the surgeon performed a gastroenterostomy (gastric bypass) with 140-c... Read more
Reader Questions:
Charge Outpatient Consult for Observation
Question: Another doctor asked my surgeon for a consult with a patient who had been admitt... Read more
Reader Questions:
Same Stay = Follow-up Consult
Question: Our surgeon was called for an inpatient consult with an auto vehicle accident pa... Read more
Reader Questions:
Packing Doesn't Guarantee Complex I&D
Question: Would you clarify the difference between a simple and complex incision and drain... Read more
Reader Questions:
Co-Surgery Status Depends on Documentation
Question: Our surgeon performed the bilateral pelvic lymph node dissection and omentectomy... Read more
Reader Questions:
Avoid 10120 for Exploration Without Removal
Question: What should we do if the surgeon explores a wound for foreign-body removal but f... Read more
You Be the Coder:
Can You Discharge a Dead Patient?
Question: Can our surgeon file a claim for pronouncing a patient dead? This sometimes requ... Read more
5 Steps Help You Reap Full Pay for Partial Colectomy Claims
Don't overlook associated procedures, or you'll be giving up reimbursement When reporting... Read more
Clip and Save:
This Helpful Tool Adds Up to Easy Colectomy Coding
 Keep score to select from 44140-44160 Here's an easy way to select among the availa... Read more
NCCI Quick Update:
Hundreds of Edits Limit Use of Size-Based Wound Care Codes
General surgery practices looking forward to reporting new-for-2005 size-specific wound ca... Read more
Hemorrhoidopexy Brings Relief, Documentation Challenges
No more unlisted-procedure code for innovative hemorrhoid treatment To establish medical ... Read more
Modifiers in Action:
Related and/or Anticipated Procedures Call for -58
2 case studies illustrate the meaning of a staged procedure To use modifier -58 properly,... Read more
Are You Ready to End Your E/M-Guideline Confusion? We Can Help
Use CMS' responses to our questions to report correct E/M levels Like many coders,... Read more
You Be the Expert:
Should You Factor Patient's Status?
Question: During an office visit, my doctor performed an expanded problem-focused history,... Read more
Bonus Question:
Improve Your Prescription Drug Documentation
Find out what CMS has to say about the management options category Calculating a patient'... Read more
Reader Questions:
Choose 99235 for Physician Who Examines Patient
Question: Dr. Smith was on-call and admitted a patient to the hospital. On the same day, o... Read more
Reader Questions:
Layers Don't Always Determine Repair Code
Question: How should I report repair of an irregular, 3.5-cm laceration of the chin involv... Read more
Reader Questions:
Check Date When Coding Admission From ED
Question: When our surgeon admits a patient to the hospital after hours from the emergency... Read more
Reader Questions:
Medicare Won't Recognize 'After-Hours' Codes
Question: Will Medicare pay extra for the surgeon seeing the patient for an unscheduled ap... Read more
Reader Questions:
Open Cholecystectomy With Cholangiogram? Here's How
Question: Which code(s) should I use to report cholecystectomy with cholangiogram and expl... Read more
Reader Question:
Let the Elements Drive Your History Documentation
Question: The chart that physicians use to select the level of history includes identifier... Read more
You Be the Coder:
Do Multiple Polyps Mean Multiple Codes?
Question: Often, the surgeon will remove several polyps via colonoscopy using the same tec... Read more
Patience Pays When Selecting a Neoplasm Dx
Wait for the pathology report and carefully review ICD-9 tables for claims success Freque... Read more
Get a Grip on Neoplasm Terminology
Our primer makes deciphering the path report easier The many categories of neoplasms ... Read more
Red Flag Alert! CMS Puts the Squeeze on Modifier -59 Claims
Don't unbundle without rock-solid documentation If you're indiscriminately using modifier... Read more
2005 Fee Schedule Update:
Don't Expect Payment for "B" Status Codes
A 1.5% increase across the board offset by some disappointing RVUs CMS has unveiled its "... Read more
News Flash:
Get Ready to Collect for Virtual Colonoscopy
Empire Medicare agrees to pay, and others could follow Beginning January 1, 2005, provid... Read more
Reader Questions:
Is There a Separate Charge for Suture Removal?
Question: During a follow-up visit at the office, the surgeon removed several sutures from... Read more
Reader Questions:
Count Out Conscious Sedation for 2005
Question: I've heard rumors that CPT will bundle conscious sedation to endoscopic procedur... Read more
Reader Questions:
Lesion Excision Often Bundles Repair Codes
Question: I'm confused about the rules for coding wound repair with lesion removal. What c... Read more
Reader Questions:
One Code Describes Hemorrhoid Removal With Fissure
Question: How can I code treatment of anal fissure during hemorrhoid removal?Arizona Subsc... Read more
You Be the Coder:
Include Margins in Lesion Measurement
Question: I've been hearing contradictory advice on how to measure lesions for removal. Sh... Read more
Size-Specific Wound-Care Codes Mean More Specific Payment for Your Practice
No longer call on 97601 for active wound care Next year, when the surgeon or nonphysician... Read more
Say Goodbye to Unlisted Procedure Codes for VAD
And say hello to improved reimbursement with 97605/97606  You can stop fretting over... Read more
New Codes Replace Carotid Artery Stenting Cat. III Codes
You should include radiologic S&I in stenting  Get ready now for two new-for... Read more
Prepare Now for Backbench Transplant Preparation Codes
CPT 2005 will include a host of codes for backbench preparation or reconstruction of donor... Read more
No More Struggling With 2 Neonatal Definitions
CPT 2005 clears the confusion with 28-day definition If you're tired of trying to remembe... Read more
Solve the Mystery of Rejected Interp Claims
Tip: Only 1 physician can bill for dx test analysis Just because your surgeon orders and ... Read more
Reader Questions:
Report Arteriogram if It Prompts Angioplasty
Question: The surgeon performed diagnostic arteriogram followed by balloon angioplasty o... Read more
Reader Questions:
Myobloc Isn't Botox, but Coding Is Similar
Question: How should I report Myobloc injections? Is Myobloc just another name for Botox?C... Read more
Reader Questions:
Reporting Endograft With Cosurgeons? Do This
Question: How should I code an abdominal aortic aneurysm (AAA) repair with more than one p... Read more
You Be the Coder:
What's the Code for Laparoscopic Vasectomy?
Question: Which code should I report for a laparoscopic vasectomy? This was done at the sa... Read more
Available Years:  2005  2004  2003  2002  2001  2000  1999