May 25, 2023 Question: My plastic surgery saw a patient who sustained an approximately 40% total body surface area burn in a fire. He has previously undergone excision and allograft placement of his extremities. He now came back for removal of the eschar that remains present on his torso and bilateral thighs. The total area...
May 11, 2023 Question: My coder says I cannot bill for taking the patient back to the OR to repair a post-op hemorrhage during the global period. She says that all complications are included in the payment for the initial surgery. Is that correct? Answer: No, that is not the case. You may bill for...
April 27, 2023 Question: When choosing the level of E/M we are confused about the History and Exam. If we choose a level of E/M based on time, does this time count toward total time, or is it only time spent on MDM? Answer: When choosing a level of E/M based on time, CPT identifies...
April 13, 2023 Question: What Modifier do I use when I have to take the patient back to the operating room to repair a post-operative hemorrhage?. My coder told me that complications are included in the payment for the original surgery. But one of my colleagues told me I can bill for the repair during...
March 30, 2023 Question: What CPT code would you use for a wound debridement when the operative notes says the wound will heal by secondary intention. Do you use a repair code? Answer: You would report a wound debridement code 1104X. The code selected would depend on anatomic location and total sq cm. You would...
March 16, 2023 Question: How should my physician document an adjacent tissue transfer? My physician documents the total in sq cm for the entire repair. Answer: The primary and secondary defect dimensions are required. The primary defect is the excision site and the secondary defect results from the flap design to perform the reconstruction. So...
March 2, 2023 Question: Our plastic surgeon routinely does repairs after Mohs surgery. What CPT code do I report for a paramedian forehead flap to reconstruct a nasal defect after Mohs surgery. Answer: The correct code to report is CPT code 15731 (Forehead flap with preservation of vascular pedicle (e.g., axial pattern flap, paramedian forehead...
February 2, 2023 Question: What does “separate procedure” mean when it follows a CPT code description? Answer: Per CPT: Some of the procedures or services listed in the CPT codebook that are commonly carried out as an integral component of a total service or procedure have been identified by the inclusion of the term “separate...
January 19, 2023 Question: We have a patient with 2 commercial payers (BCBS and Cigna). A consultation code was submitted to BCBS, and they paid according to our contract. However, Cigna is refusing to process the claim since they no longer pay for consult codes. Am I allowed to change the CPT code and rebill...
December 15, 2022 Question: In 2023, will the level of service be determined by history, exam and medical decision making, or will this change? I have heard it is changing. Answer: Beginning January 1, 2023, consultation codes 99242-99255) for both inpatient and outpatient services will be based on medical decision making or time. However, keep...
