I have a case where the doctor is scheduling with just a panniculectomy procedure and I code for the facility. And when I code the case out per the dictated op report, I am using CPT 15830 and 15847. I brought this matter to their attention that they should be scheduling these cases with both procedures for an authorization. And if the one procedure is denied; that we give the patient an option to pay for this at a reduced cosmetic hourly rate; instead of a large balance that has been put to the patients responsibility. The doctor feels that the whole surgery case is only one procedure CPT 15830; that is what the office only bills out. It's OK for the patient not to have an umbilical? The doctor states that other institutions do not have a problem coding it this way. Why do we?
Has anyone else run into this kind of an issue? Does the following op report warrant using the add-on procedure? My concern is being audited.
Began the procedure by using a 10 blade to incise the inferior incision. The abdominal flap was raised taking care to avoid damage to the lateral femoral cutaneous nerve by leaving a large cuff of fatty tissue. Vessels were cauterized and ligated as needed. Once at the level of the umbilicus, 2 single hooks were inserted and a 15 blade was used to incise around the umbilicus. Dissection was carried down to the fascial wall leaving a large cuff of fatty tissue to provide blood supply. The 12 o'clock position was marked with a Vicryl stitch. The flap was then transected centrally and elevation continued up to the level of the xiphoid and costal margins. The patient was then sat up in the sitting position and the upper incision marked. She was placed back in the supine position and a 10 blade was used to incise the upper incision followed by cautery. Meticulous hemostasis was achieved after irrigation under normotension. The patient was then put back in the flexed position. Quilting sutures were performed in a 19 French drain placed and secured. The central portion of the incision was then closed with 2-0 Vicryl at the scarpa level. Prior to this the position of the umbilicus was marked. We then proceeded with a layered closure using 3-0 and 4-0 Monocryl strata fix. The needle umbilicus position was then incised using a 15 blade and dissection carried through the abdominal flap to the umbilicus which was transposed into the new position. This was secured using a combination of 3-0 Monocryl and 5-0 fast for the skin, Dressings were applied and abdominal binder.
Has anyone else run into this kind of an issue? Does the following op report warrant using the add-on procedure? My concern is being audited.
Began the procedure by using a 10 blade to incise the inferior incision. The abdominal flap was raised taking care to avoid damage to the lateral femoral cutaneous nerve by leaving a large cuff of fatty tissue. Vessels were cauterized and ligated as needed. Once at the level of the umbilicus, 2 single hooks were inserted and a 15 blade was used to incise around the umbilicus. Dissection was carried down to the fascial wall leaving a large cuff of fatty tissue to provide blood supply. The 12 o'clock position was marked with a Vicryl stitch. The flap was then transected centrally and elevation continued up to the level of the xiphoid and costal margins. The patient was then sat up in the sitting position and the upper incision marked. She was placed back in the supine position and a 10 blade was used to incise the upper incision followed by cautery. Meticulous hemostasis was achieved after irrigation under normotension. The patient was then put back in the flexed position. Quilting sutures were performed in a 19 French drain placed and secured. The central portion of the incision was then closed with 2-0 Vicryl at the scarpa level. Prior to this the position of the umbilicus was marked. We then proceeded with a layered closure using 3-0 and 4-0 Monocryl strata fix. The needle umbilicus position was then incised using a 15 blade and dissection carried through the abdominal flap to the umbilicus which was transposed into the new position. This was secured using a combination of 3-0 Monocryl and 5-0 fast for the skin, Dressings were applied and abdominal binder.
