Category: CC-Plastic Surgery

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Modifier 57: Decision for Surgery

June 9, 2016 Question: I saw a patient on a Friday and scheduled elective surgery for the following Monday. Do I need a 57 modifier on the E/M code I did on Friday? Answer: Modifier 57 is required on an E/M code that is the decision for surgery visit if the visit occurs the day...

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Transitional Care Management Codes

We’ve been using the transitional care management codes, 99495-99496, for post-op discharge care (e.g., writing prescriptions, dictating the discharge summary) while the patient is in the hospital after surgery for breast reconstruction or flap reconstruction procedures. Medicare has been denying the codes. Should we appeal these denials?

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Excision of Scar

Patient comes in for what they are calling scar revision and the note states that "standing cutaneous excess of the left abdominal scar” was sharply excised. We are billing with a diagnosis of hypertrophic scar (L91.0) and CPT codes of 11406 (excision of benign lesion) and 12034 (intermediate repair) for the procedure. On speaking with a co-worker regarding the note, since I’m new to plastics surgery, we are wondering if we should bill 15830 with 52 modifier because it appears to me that the excess skin is being removed. What do you think?

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