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General Surgery Coding Alert

Quick Chart Makes Your Skin Replacement Coding a Snap
Not all code ranges follow the same rules, so read the  descriptors carefullySelectin... Read more
Watch POS Requirements With 99217-99220 and 99234-99236
State law may govern whether a patient is -in- or -out- Although the wrong place-of-servi... Read more
UPDATE ~ Make Sure You Properly Report AlloDerm During Hernia Repair
49568 isn't the answer, AMA says In July, General Surgery Coding Alert reported that... Read more
Heads Up:
A New, Mandatory CMS-1500 Form Is on the Way
You-ll likely have to make software changes, so get started now By April 2007, you-ll hav... Read more
Reader Question ~ Making the Most of Telephone Time
Question: I-ve been advised in the past that I cannot be paid for time the physician spend... Read more
Reader Question ~ Find Modifier 51 Exemptions Fast
Question: I heard a colleague discussing CPT codes that are exempt from modifier 51. How c... Read more
Reader Question ~ Choosing a Modifier for 2 Services
Question: We performed an inpatient consultation and decision for esophagogastroduodenos... Read more
Reader Question ~ Restrictive Procedure Calls for 'Unlisted' Code
Question: Which is the best code to report laparoscopic gastric restrictive procedure with... Read more
Reader Question ~ 'Separate Procedure' Might Not Mean What You Think
Question: What does the term -separate procedure,- as used in CPT, indicate? Does this mea... Read more
You Be the Coder:
Do Separate Excisions Mean Separate Codes?
Question: If our physician debrides two sites with infected decubiti, should we report eac... Read more
Don't Allow Missed Appendectomy Opportunities to Burst Your Reimbursement
A distinct Dx goes a long way in proving the separate -- and separately payable --nat... Read more
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Questionnaire Helps You Choose The Appropriate Appendectomy Code
Questionnaire Helps You Choose The Appropriate Appendectomy CodeTo make your appendectomy ... Read more
'After-Hours' Rules Changed -- Have You Kept Pace?
Unscheduled visits could call for special coding, increased paymentWhen you offer services... Read more
After-Hours Service Codes Made Easy
Looking for a quick and easy way to understand all the changes to after-hours codes? Check... Read more
Reader Question ~ Dermabond Coding Depends on Payer
Dermabond Coding Depends on PayerQuestion: How can we code for using tissue adhesives, suc... Read more
Reader Question ~ Break Down HPI for Maximum Efficiency
Break Down HPI for Maximum Efficiency Question: An internal chart audit of our E/M claims... Read more
Reader Question ~ When to Report Biopsy Separately
When to Report Biopsy SeparatelyQuestion: We often perform sentinel node biopsy and, if th... Read more
Reader Question ~ Watch Bundling Issues With Sphincterotomy
Watch Bundling Issues With SphincterotomyQuestion: Is sphincterotomy included in hemorrhoi... Read more
You Be the Coder ~ Graft Site Preparation Always Separate?
Question: I notice that CPT 2006 added two new codes (15000 and 15001) for site preparatio... Read more
When Is Foreign Body Removal Not Foreign Body Removal? The Answer You Need Is Here
Location and depth are crucial--but not enough--to guide your code selectionIf the surgeon... Read more
Call on 22 if Your Surgeon Goes the Extra Mile
22 means more work for coders, too--but the payoff can be worth itWith appropriate documen... Read more
Heads-Up:
Tissue Transfers Still Include Lesion Excisions
NCCI bundles remain in effectIf you had hoped you could report lesion excisions (11400-116... Read more
READER QUESTIONS:
'Hand-Assisted' Laparoscopy Is Still Laparoscopy
Question: What is, and how should I code for, -hand-assisted laparoscopy-?Texas Subscriber... Read more
READER QUESTIONS:
CPT Bundles Many Services to Critical Care
Question: Our surgeon performed 64 minutes of critical care for a patient in cardiac arres... Read more
READER QUESTIONS:
Purpose Differs for Fine Needle and Puncture Aspirations
Question: How can I distinguish fine needle aspiration from puncture aspiration? What make... Read more
You Be the Coder:
Test Your FBR Coding Competence
Question: A piece of wood split and lodged in a construction worker's right forearm. There... Read more
4 Tips Will Take the Pain Out of Reporting Hemorrhoid Procedures
 Location matters more than number for all removal methods With multiple codes to... Read more
CMS Clarifies Modifier 25 Use, Could Issue a Crackdown
Same-day E/M with identical Dx?  You now have ammunition with payers A recent CMS me... Read more
Colonoscopy Confusion May Have Only 1 Solution
Carriers differ on primary diagnosis for -diagnostic- screenings The confusion over how t... Read more
Reader Questions:
Sclerotherapy Payment May Hinge on 454
Question: Does Medicare cover sclerotherapy for varicose veins with 36470 and 36471? If so... Read more
Reader Questions:
Stay Away From 53 for Lap Chole Conversion
Question: Our surgeon began a laparoscopic cholecystectomy but, due to inflammation, conve... Read more
Reader Questions:
Make Bronchitis Dx as Specific as Possible
Question: When I use 491.9 to describe a patient's bronchitis, payers often deny the code ... Read more
Reader Questions:
Depth Makes a Difference for Hematoma Drainage
Question: The patient underwent a mastectomy. After closing, she developed a large hemat... Read more
Reader Questions:
Focus Your Colonoscopy Coding on These 2 Words
Question: When performing a colonoscopy, a surgeon finds a miniscule polyp. He applies the... Read more
Reader Questions:
Ratchet Up Your ROS
Question: What are the differences among ROS levels?California Subscriber Answer: Four re... Read more
You Be the Coder:
What About Stones During Lap Chole?
Question: During a laparoscopic cholecystectomy (lap chole), the surgeon found a few stone... Read more
Not All Lymph Excisions Are Equal:
Find Out What Makes the Difference
What you need to get paid for lymph excisions in combination with other breast tissue exci... Read more
Coding Basics:
'New' or 'Established' Might Matter More Than You Think
2 questions allow you to pick the right code -- and right level -- every time When report... Read more
Medicare Update:
Take Steps to Avoid Growing Consult Confusion
You aren't responsible for the requesting physician's files, CMS says Recent Medicare rul... Read more
Reader Questions:
Payer Holds the Cards for 91110 Diagnoses
Question: What are the proper CPT and ICD-9 codes to report for using the -gut cam-?Florid... Read more
Reader Questions:
'Uncertain' ICD-9 Means 'Benign' CPT
Question: The pathologist was unable to determine if a lesion the surgeon removed is malig... Read more
Reader Questions:
Payers Differ on Dermabond Coding Rules
Question: An elderly patient arrived at the office with a 1.4-cm skin tear on his left thi... Read more
Reader Questions:
Get Specific With New Decubitus Ulcer Diagnoses
Question: The surgeon treated a patient with decubitus ulcers on his right hip and buttock... Read more
Reader Questions:
Adjustments of Gastric Lap Bands
Question: How should I code for in-office adjustments of gastric lap bands? Can I report 4... Read more
You Be the Coder:
What Constitutes Foreign-Body Removal?
Question: Our surgeon saw a patient in the office who had several small metal filings embe... Read more
Are You Reporting 43246 for All Gastrostomy Placements? Not So Fast
Without a careful reading of the op note, you-re probably coding incorrectly Not all g... Read more
3 Ways to Nourish Your Related PEG Procedure Coding
Can't find a code for PEG tube removal? Here's why Placement is only part of the story fo... Read more
4 Options Take the Mystery Out Of Suture Removal Coding
Here's why 15850-15851 with modifier 52 is not an option Reporting suture removal procedu... Read more
Think Twice About Modifier 55
Coordinated coding is necessary to receive payment When a different physician removes sut... Read more
Reader Questions:
Mesh Isn't the Only Prosthesis for Hernia Repair
Question: How should I report the use of AlloDerm (human regenerative tissue), rather than... Read more
Reader Questions:
Don't Overlook V Codes
Question: I-ve heard again and again that I shouldn't use a V code as a primary diagnosis.... Read more
Reader Questions:
VAC Now Pays With Correct Dx
Question: I-ve heard that we can now bill Medicare for VAC therapy (as of 2006). Is this t... Read more
You Be the Coder:
Are 15300-15301 Appropriate for Graft Changes?
Question: Our surgeons often use allograft for temporary wound closure (for example, 15300... Read more
5 Steps Take the Heat Out of Burn Diagnoses
Make sure you know the questions to ask to choose the proper codeWith some diagnoses, ther... Read more
Rely on 'Rule of Nines' to Determine Burn Percentages
Infants require different figuresTo assign the required fourth and fifth digits for diagno... Read more
Here's What You Need to Know Most About NCCI 12.1
With more than 10,000 changes in the latest National Correct Coding Initiative quarterly u... Read more
New Sedation Bundles Could Limit Your Options
NCCI 12.1 takes aim at sedation with endoscopiesThe National Correct Coding Initiative ver... Read more
READER QUESTIONS:
ON-Q Might Not Pay What You Think
Question: What is the correct code for placement of an ON-Q pain pump for post-procedure p... Read more
READER QUESTIONS:
Pass the Splenic Flexure, Report Colonoscopy
Question: Our doctor attempted a colonoscopy with decompression. He passed the splenic fle... Read more
READER QUESTIONS:
Global Re-Excision Calls for a Modifier
Question: The patient underwent a partial mastectomy of the left breast nearly two months ... Read more
READER QUESTIONS:
Method Doesn't Matter for Control of Bleeding
Question: My doctor has been using an Argon laser to control bleeding, whether in the colo... Read more
READER QUESTIONS:
Paper Claim Doesn't Have to Mean Slow Filing
Question: We have difficulty filing paper claims for unlisted-procedure codes. Our payer s... Read more
READER QUESTIONS:
Tube Conversion Calls for Endoscopy
Question: How can I report a PEG tube to J-tube conversion?Ohio Subscriber Answer: In mos... Read more
You Be the Coder:
When Does Excision Become Mastectomy?
Question: What is the line between codes 19120 and 19160? Does the surgeon have to documen... Read more
Perfect Your Bariatric Surgery Coding -- You'll Likely Submit More Frequent Claims
Cholecystectomy and/or appendectomy may count as separate procedures Medicare has recentl... Read more
Update:
CMS Delivers on Bariatric Surgery Coverage
Benefits are more generous than expected Beginning immediately, you-ll be able to offer a... Read more
5 Quick Answers Teach You About Critical Care
Not all ICU patients are critical, and not all critical patients are in the ICU If rep... Read more
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Quick-Reference Critical Care Chart
Make reporting critical care easy with this simple chart. Just check the physician's docum... Read more
Reader Questions:
Exploration/Revision Describes Graft Removal
Question: Our surgeon excised an infected Gortex dialysis graft from the left arm. Which c... Read more
Reader Questions:
'En Bloc' Alone Calls for 38100
Question: A patient has undergone en bloc splenectomy. This is the only procedure the surg... Read more
Reader Questions:
Any Doctor Can Use ED Codes
Question: An emergency department (ED) physician asked our surgeon to see a patient with s... Read more
Reader Questions:
Screening-vs.-Diagnostic Rules Haven't Changed
Question: I read that Medicare has just changed its policy regarding screening vs. diagnos... Read more
Reader Questions:
Treat All Adenoidectomies With Tonsillectomy the Same
Question: When reporting adenoidectomy with tonsillectomy, does it matter if the adenoid... Read more
You Be the Coder:
What's the Status of Post-Op Mesh Removal?
Question: The patient had a hernia repair by another surgeon more than 90 days ago and now... Read more
Watch for 'Family Ties' When Reporting Same-Day Scopes
Remember the multiple-scope rule when coding, checking reimbursementIf you-re reporting mu... Read more
There's a Quick Way to Identify Scope 'Families':
Here's How
CPT usually groups constituent codes with parentCPT and CMS group endoscopic codes into -f... Read more
New Consult Rules Mean You'll Be Beefing Up Documentation
Requesting physician must note consult in plan of careThe -Three R-s- aren't enough anymor... Read more
Use This Sheet to Coordinate Your Consult Documentation
New Medicare rules outlined in Medlearn Matters article MM4215 stipulate that both the con... Read more
READER QUESTIONS:
Decide Between 22 and Unlisted-Procedure Codes
Question: How should I determine when to report a specific CPT code with modifier 22 rathe... Read more
READER QUESTIONS:
Include Evaluation With Scheduled Procedure
Question: The surgeon meets with a patient and recommends a breast biopsy, which the patie... Read more
READER QUESTIONS:
HEM Now Counts for Nursing Care
Question: Our surgeon recently performed a re-admission assessment for a nursing home pati... Read more
READER QUESTIONS:
Wait for Diagnosis to Report Code
Question: Can we code a condition or disease if the physician notes in the documentation t... Read more
You Be the Coder:
What Are the Rules for Neoplasm Dx?
Question: When diagnosing neoplasms, how should I choose from among the various categories... Read more
Read GI Surgery Op Notes Carefully to Reveal Hidden Cash
Earn an extra $1,000 by coding the correct approach Adding a single -extra- procedure dur... Read more
Are You Giving up Hundreds in Abdominal Surgery Coding?
You can report 49002 when the surgeon reopens the wound If your surgeon is re-exploring a... Read more
Are You Giving up Hundreds in Abdominal Surgery Coding?
You can report 49002 when the surgeon reopens the wound  If your surgeon is re-explo... Read more
Call on 24 for Complication Evaluations Post-Op--Maybe
Medicare will only allow payment for return to the OR If your surgeon sees patients ... Read more
Correction:
Never Bill More Than 1 Unit of 99218-99220 per Stay
The January 2006 General Surgery Coding Alert included a typographical error on page 7, in... Read more
Get the Truth About Multiple, Same-Day E/M Services
With effort, you can get payment for unrelated problems If a patient visits your office ... Read more
Reader Questions:
Unrelated Venous Access Calls for 79
Question: The patient underwent colectomy to remove cancerous tissue. During the procedure... Read more
Reader Questions:
Don't Be So Quick to Bill Admission
Question: Our surgeon performed skin grafts for a Medicare patient with extensive burns on... Read more
Reader Questions:
Don't Rely on 'Biopsy' for Coding Guidance
Question: How should I code for an -excisional biopsy-? Is this a biopsy only, or is it tr... Read more
Reader Questions:
Stick With 'Open' Codes for Conversions
Question: If the surgeon performs a substantial portion of a cholecystectomy laparoscopica... Read more
You Be the Coder:
How Do You Dx More Than 1 Severity Level?
Question: How should I choose codes from the 940-947 series if a patient has both first- a... Read more
CPT 2006 Shows More Skin--and New Technologies Will Benefit
You-ll have to differentiate between layers of skin when applying graft codes Skin graft ... Read more
You Should Separately Report Site Preparation With Burn Repairs
Prior to applying a skin (or skin replacement) graft, the surgeon will normally prepare th... Read more
News That Matters:
Medicare Set to Expand Bariatric Surgery Coverage
Your practice can have a say during the comment period A recent memo issued by CMS could ... Read more
Want the Facts on Conscious Sedation? Get Them Here
Be sure to bundle CS to all procedures in Appendix G CPT 2006 includes a major overhaul ... Read more
CS:
Don't Expect Medicare to Change Its Ways
In years past, Medicare considered conscious sedation procedures 99141-99142 bundled servi... Read more
Wake Up and Learn Your New CS Codes
You-ll have to document patient age and procedure time Revisions in CPT 2006 mean you wil... Read more
Correction:
Separate Unna Boot, Debridement Must Occur on Different Legs
You can report debridement (for example, 11040, Debridement; skin, partial thickness) duri... Read more
Reader Questions:
Extra Cleaning Earns Intermediate Repair
Question: Our surgeon removed extensive debris from a wound that then required a single-la... Read more
Reader Questions:
Look to Lesion Excision for Mole Removal
Question: What is the appropriate code for -removal of mole-? I-ve searched the entire CPT... Read more
Reader Questions:
Argon Plasma = Control of Bleeding
Question: Our surgeon performed an EGD with Argon plasma coagulation for control of bleedi... Read more
Reader Questions:
Count Readmission as Separate Service
Question: The surgeon discharges a patient and readmits him to the same hospital the next ... Read more
You Be the Coder:
What's the Code for Lap Catheter Placement?
Question: How can we report placement of a laparoscopic Tenckhoff dialysis catheter?Oregon... Read more
Bariatric Surgery Code Overhaul:
The Laparoscopic Banding Code You've Waited for is Here
"Apply modifier 52 with 43770 for placement of an individual componentAfter years of repor... Read more
Medicare Slashes Conversion Factor 4.4 Percent for 2006
Congress could still act to prevent cutsYou can expect your payments from Medicare to shri... Read more
Now's the Time to Update Your Consult Coding
Mandated services mean modifier 32CPT 2006's deletion of follow-up inpatient (99261-99263)... Read more
4 Rules Help You Take the Mess Out Of Mesh
Modifier 22 is the choice for difficult removal during hernia repairMesh placement may be ... Read more
Rest Home Coding Is Easier Than You Think
Lack of medical component identifies place-of-service 33You may be tempted to report eithe... Read more
Coming Next Month:
More CPT 2006 Information
Look to the February 2006 General Surgery Coding Alert for even more valuable information ... Read more
READER QUESTIONS:
Removal Includes Biopsy
Question: Can I not report a biopsy (45380) on the same day as removal (for instance, 4538... Read more
READER QUESTIONS:
Redo Nissen Calls for New Nissen Code
Question: The surgeon performed a redo laparoscopic Nissen, but the original surgery was m... Read more
READER QUESTIONS:
Stick With 99218-99220 for 8 Hours or Fewer
Question: We have a long-standing argument in our office regarding the proper use of obser... Read more
READER QUESTIONS:
Separate Documentation Important for Modifier 62
Question: Recently, our surgeon placed a PEG tube during the same session that a gastroent... Read more
You Be the Coder:
Is Control of Bleeding Bundled?
Question: Can we gain additional reimbursement if our surgeon performs a flexible sigmoido... Read more
Available Years:  2006  2005  2004  2003  2002  2001  2000  1999