Wiki Billing for repair of surg access site requiring reconstruction

[dmcvinney]

Hi, all,

Patient had orbital fracture, doctor had to access the fracture via the canthus. Doc billed for fracture repair and Canthoplasty.

I felt funny about billing for the canthoplasty, since there was no injury to the canthus; it was just used as access for repair, so I discussed it with the doc. He feels the canthoplasty billing is appropriate.

He said that:
-in this particular patient's case it was necessary to access the fracture via the canthus
-more than simple closure was required, he actually had to reconstruct the canthus in order to finish the repair
-in situations like these he does not always have to do a Canthoplasty (or access in this way), but in this patient's case it was necessary
He asked that I bill the canthoplasty in addition to the orbital fracture repair.

Perhaps this is akin to excision of lesions where, if more than simple closure is needed, a physician is instructed in CPT to bill the intermediate or complex repair codes in addition to the lesion removal?

What are your thoughts? Has anyone encountered this situation? Not bundled. . .and as always, written references supporting your thinking are appreciated, if you know of any.

Thanks!


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Diane Mcvinney, CPC, OCS
Billing Manager, Jones Eye Institute
University of AR for Medical Sciences
DLMcvinney@...
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[FTessaBartels]

Incidental

For an accurate response to a surgical coding question, please post the scrubbed operative note.

It's hard to say for certain because I haven't seen the operative note.

However, in general, I would consider this akin to the situation a general surgeon encounters when performing a laparoscopic procedure and finding an umbilical hernia at the port site. He doesn't USUALLY repair a hernia when he's doing a lap appy (for example), so this requires a little more work, but since it's the same incision used to the primary procedure, the umbilical hernia repair is considered incidental and is not coded.

I would consider the repair he performed as incidental to the orbital fracture repair. It may have requried a bit more work than he usually performs, but I don't consider it a separately codeable procedure.

Hope that helps.

F Tessa Bartels, CPC, CEMC