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 16, 2023 Question: Can we code 97605 for a wound vac when the wound is closed and a wound vac is placed? Answer: CPT codes 97605/97606 are reported for negative pressure wound therapy when the wound vac is placed on an open wound. You may also report when wound is debrided or excised and...
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...
December 1, 2022 Question: My physician is insisting that I bill an excision biopsy using a punch as a punch biopsy (11104). The documentation says the lesion was removed in its entirety. Is this a biopsy of lesion excision. She does not document the cm size of the removal. Answer: Skin biopsy procedures can be...
November 17, 2022 Question: What CPT code do I use to report the repair of the cleft lip with a cross lip pedicle flap and sectioning and inserting the pedicle? I was told to report CPT 40527 Answer: The correct code to report is 40761. CPT 40527 does not include sectioning and inserting the pedicle....
November 3, 2022 Question: My physician performed two soft tissue tumor excisions in different areas on the scalp. They measured 1.0 cm and 1.5 cm. Can I bill for both? Also can I report a layered closure. Answer: You would report CPT 21011 (excision soft tissue tumor, scalp 2cm or less) for the first excision...
