Wiki Buccal Release

[AN2114]

The doctor did a buccal cheek release and a lingual frenuloplasty. For the buccal cheek release I have cpt code 40819 and the doctor said buccal cheek release x4. Do I change the unit to 4 or does this code include any amount of releases?

I also looked up NCCI edits to see if I can code 41520 with 40819 and there is no edits but I wasn't sure if I could code them together since it's in the same area. Any thoughts? Here is the op report:

Operative procedure: Lingual frenuloplasty, labial frenuloplasty, and buccal cheek frenuloplasty release x4 of upper maxilla and mandibular.

Procedure: The patient was seen in preop. The patient was brought back to the OR suite. The patient underwent mask sedation. Once properly sedated, we did examine the upper lip and release that using a needle tip Bovie set on 8. We then reapproximated the tissues after elevating submucosal folds with 4-0 chromic x2. It was significantly restricting the upper lip movement. We then examined the lingual frenulum underneath the tongue. We did isolate the lingual frenulum and using needle tip Bovie set on 8. We were able to release the lingual frenulum. We make sure that we did go into the back posterior musculature of the tongue. Upon doing so, we then did elevate submucosal flaps and reapproximated and lengthened the tissue of the tongue with 4-0 chromic x4. We did submucosally lay these in a proper manner so that way the tongue was able to move properly. We then did turn attention to the upper maxillary buccal folds. We did release both of these using electrocautery and this would be x2 above and that would be set on 8. We make sure that it was good proper release and proper motion around the maxilla. We then identified the lower mandibular folds as well, which we did release these were also buccal folds using a #8 cautery and make sure there was proper motion there as well. We did tell mother that she would need to do extensive exercises afterwards and also seek how to speech language as well as occupational therapy to make sure that these did not reattach. We did discuss everything at length.

 

[b.cobuzzi]

Actually, in reading the note, the surgeon did 6 releases, the upper lip frenulum, the lingual frenulum under the tongue, two upper buccal releases around the maxilla and 2 lower buccaneers around the mandibular folds.

But 40819 has a MUE in the fee schedule (maximum units in a day) of 2, meaning that you are not going to get paid for more than two. I would bill 40189 times 2 units and add a 22 modifier for increased service on 40819 and increase your fee to 6 times the normal fee for one release. In Box 19 explain that the 22 modifier was used because 6 releases were performed and list the location of the 6 releases. You will have to appeal the 22 modifier and the extra money that is associated with it because the extra money never comes the first time the claim is processed. Still send in the claim electronically so you do not have a timely filing problem (you can prove timely filing) and then once it paid like 2 units (or more likely, like 1 unit because the payer even ignored your 2 units, appeal the payment and include the op note and explain in the appeal that the 6 releases were performed, again giving each location. I would also circle each release in the op note. Do not highlight them because highlighted text turns black when scanned. Just circle them. You may have to appeal to 2 or 3 levels, but you should get some extra money after doing the appeals with your documentation. In the future, if you have a case like this, ask the doctor if he/she can dictate a “findings” paragraph which outlines the increased complexity, so in this case, it would list the 6 locations that were released which is beyond normal.

 

[AN2114]

Actually, in reading the note, the surgeon did 6 releases, the upper lip frenulum, the lingual frenulum under the tongue, two upper buccal releases around the maxilla and 2 lower buccaneers around the mandibular folds.

But 40819 has a MUE in the fee schedule (maximum units in a day) of 2, meaning that you are not going to get paid for more than two. I would bill 40189 times 2 units and add a 22 modifier for increased service on 40819 and increase your fee to 6 times the normal fee for one release. In Box 19 explain that the 22 modifier was used because 6 releases were performed and list the location of the 6 releases. You will have to appeal the 22 modifier and the extra money that is associated with it because the extra money never comes the first time the claim is processed. Still send in the claim electronically so you do not have a timely filing problem (you can prove timely filing) and then once it paid like 2 units (or more likely, like 1 unit because the payer even ignored your 2 units, appeal the payment and include the op note and explain in the appeal that the 6 releases were performed, again giving each location. I would also circle each release in the op note. Do not highlight them because highlighted text turns black when scanned. Just circle them. You may have to appeal to 2 or 3 levels, but you should get some extra money after doing the appeals with your documentation. In the future, if you have a case like this, ask the doctor if he/she can dictate a “findings” paragraph which outlines the increased complexity, so in this case, it would list the 6 locations that were released which is beyond normal.

Thank you!!