We had a patient with multiple lipomas, requiring 8 separate incisions in different areas, ranging from the arm to the back to the abdomen. They were through 8 separate incisions, so I coded all that were of different sizes through different incisions, ending up with a lot of codes and a few repair codes (since repairs are added together if in the same area). Is there a limit to the number of excision codes/repair codes that can be submitted on one patient? Or is this a decision that would be made by the business office if they stop charging after a certain number of codes? The patient is upset at the total of the bill. Thanks for any help.
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Wiki billing of multiple lipomas
- Thread starter ms123
- Start date
CPCCODERII
Guest
I always code it as its dictated, so if they removed 8 lesions I agree with billing for the procedures. We use M's on the additional codes to reduce the RVU's that are paid to our providers and if a self pay we will give a discount on the subsequent codes. Did the patient require intermediate repair of the defects left by the excisions? I am just questioning why repair codes were billed. Also wondering if the patient was notified before the procedure that it may not be covered by insurance?
mitchellde
True Blue
Sorry the patient is up set.. however 8 were removed and that is what I would charge along with the intermediate repair. You should discount the second and subsewuent procedures for the self pay just as the insurabce will do since all were performed in the same setting.
When we code the removal of lipomas we do not charge and additional code for the interm. closure due to the description in the Coder's desk reference stating "the incision is repaired with layers of sutures, staples or steri-strips." The code includes layer closure.
mitchellde
True Blue
A simple closure is included but an intermediate repair is always coded in addition to the excision.
ARCPC9491
True Blue
I agree with what you coded and all that ... but if the patient is self pay, did they not know of the cost prior to the procedure? or at least an estimated cost? If we have a self pay patient, they know of the cost, pay up front, sign their waivers and consents and the show goes on ... that way no one gets upset and everything is explained/answered prior to the procedure.