October 18, 2018 Question: I recently attended a coding course you taught and learned a lot – thank you! I will say though that I am slightly confused by one thing you said… a history in the op note? I have never put any history in an op note. Where do you put any kind...
Category: Plastic Surgery
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Diagnosis Coding for Suspicious Skin Lesion
October 4, 2018 Question: My billing service is waiting for the pathology report and assigning the diagnosis and procedure code for benign or malignant skin lesion removal. This I completely understand. However, they are asking me to amend my procedure note accordingly once the pathology report is back. This is a lot of extra work...
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Care of Tissue Expander Outside the Global Period
September 20, 2018 Question: We are still expanding the TE outside of the global period from the breast reconstruction with placement of the TE. How do we bill this? Answer: There is not a specific CPT code for doing a tissue expander expansion. Therefore, it is just part of your E/M code for the service...
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Cosmetic Rhinoplasty and a Functional Septoplasty
September 6, 2018 Question: If I do a cosmetic rhinoplasty and a functional septoplasty on a patient, should I document both procedures on the same operative note? Or should I document a separate operative note for each procedure? Answer: Good question! In KZA’s experience, it is best to document one operative note for all procedures...
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Tissue Grafting
August 23, 2018 Question: What code do I report when a patient has a previous breast reconstruction (4 months ago) and prevents for a revision. The physician performed fat injections in both breasts. Answer: You would report CPT code 20926-50 (Tissue grafts, other (eg, paratenon, fat, dermis) or 20926-RT, 20926-LT depending on what your payor...
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Diagnosis Code for a Scar Contracture
August 9, 2018 Question: What ICD-10-CM diagnosis code do I report for a patient seen for a release of scar contracture of the flexor surface of the left elbow after healing of a third degree burn? Answer: You would report L90.5 (scar conditions and fibrosis of the skin) and T22.322S (Burn of third degree of...
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Discontinued Procedure
July 26, 2018 Question: I was excising a 2.5cm lipoma on the patient’s back in the office. One the skin was opened I observed that there was a pulsatile mass from the vein. I was concerned that this could be a large vascular structure so I discontinued the procedure to avoid potential massive bleeding? Can...
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Wound VAC
July 12, 2018 Question: I performed a superficial debridement of the sternum with a 5 x 5 cm placement of Integra to the sternal wound. Can I bill for the wound VAC? Answer: Since the wound VAC is acting as a dressing it should not be reported separately. You should report CPT 15002 for the...
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Excision with ATT
June 28, 2018 Question: My physician wants to code 14021 and 11606 for an excision and rotation flap to close an 18sq cm defect. Is this correct? Answer: When adjacent tissue transfer or rearrangement is performed in conjunction with excision of a lesion, the lesion excision is not reported separately. The only code you should...
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Coding a Composite Graft with Harvested Cartilage
June 14, 2018 Question: I performed a composite graft (CPT 15760), and harvested cartilage from the ear. Can I report for the harvesting? If yes, what code do I use? Answer: You can report both 15760 (Graft; composite (eg, full thickness of external ear or nasal ala), including primary closure, donor area) and CPT 15040...