ljones88
Networker
Hi all,
Office manager is trying to obtain precert from insurance for a scheduled surgery and I'm trying to compile a list of codes that the dr may bill. Patient will need to undergo excision of nasal and lip scars with advancement flap closures. Patient fell a few months ago and the wounds have not healed properly.
Without the op note in front of me, I can't advise what codes to bill however after researching online I have come up with this:
Billing:
-14060 (Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less)
OR 14061 (Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10.1 sq cm to 30.0 sq cm )
AND
-15004 (Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1% of body area of infants and children )
OR if no seperate incision is made consider billing:
-13151 (Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm)
OR
-13152 (Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm)
and +13153 assuming the wound is that large (Repair, complex, eyelids, nose, ears and/or lips; each additional 5 cm or less )
My issues is this: Can we bill 14060 (assuming it's done) for an excision of scar with advancement flaps or does CPT allow excision of scars to only be reported with complex repairs?
I'm prepared to tell the manager to obtain precert on all codes just to be safe and avoid having to update the auth the morning of surgery in case the physician changes his mind in the OR (e.g. plans for 14060 but decides complex repair is only necessary)
Thank you so much!
Office manager is trying to obtain precert from insurance for a scheduled surgery and I'm trying to compile a list of codes that the dr may bill. Patient will need to undergo excision of nasal and lip scars with advancement flap closures. Patient fell a few months ago and the wounds have not healed properly.
Without the op note in front of me, I can't advise what codes to bill however after researching online I have come up with this:
Billing:
-14060 (Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less)
OR 14061 (Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10.1 sq cm to 30.0 sq cm )
AND
-15004 (Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1% of body area of infants and children )
OR if no seperate incision is made consider billing:
-13151 (Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm)
OR
-13152 (Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm)
and +13153 assuming the wound is that large (Repair, complex, eyelids, nose, ears and/or lips; each additional 5 cm or less )
My issues is this: Can we bill 14060 (assuming it's done) for an excision of scar with advancement flaps or does CPT allow excision of scars to only be reported with complex repairs?
I'm prepared to tell the manager to obtain precert on all codes just to be safe and avoid having to update the auth the morning of surgery in case the physician changes his mind in the OR (e.g. plans for 14060 but decides complex repair is only necessary)
Thank you so much!