Category: CC-Plastic Surgery

Takeback to OR
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Takeback to OR

May 19, 2022 Question: I had to take a patient back to the operating room 6 weeks after breast reduction to excise a small dehiscence and close the wound. Can I bill for this? Answer: Yes, you may bill for the service and you’ll need to use modifier 78 (return to the OR for a...

Level 5 Office E/M Code
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Level 5 Office E/M Code

April 7, 2022 Question: I was told that if I recommend surgery then I can automatically bill 99205 or 99215. This seems too good to be true. Please advise. Answer: You’re right – you’ve been given inaccurate information. Remember, office visit codes (99202 – 99205, 99212 – 99215) require meeting or exceeding two of the...

Capsulectomy with Breast Reconstruction Implant Exchange
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Capsulectomy with Breast Reconstruction Implant Exchange

March 24, 2022 Question: We billed 19371 (capsulectomy) with a breast reconstruction implant exchange (19342 – larger to smaller). We were denied 19371. Should we have used modifier 59 on 19371 to get paid? Answer: This Medicare National Correct Coding Initiative (NCCI) edit is a dilemma. CPT implies that you are allowed to use both...

Nasal Fracture Denial
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Nasal Fracture Denial

February 24, 2022 Question: We precertified and billed a nasal fracture CPT code. The payor requested the operative note which we sent. The payor then denied the procedure and said we didn’t bill the right code. I don’t understand. Answer: After reading the operative note you sent, I understand the denial. The Indications said the...

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