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General Surgery Joba Studio General Surgery Joba Studio

Selective Debridement of Multiple Ulcers 

Selective debridement was performed on 3 separate ulcers, 3 ulcers of the distal legs; 2 are on the right leg and 1 is on the left leg.

Question:

Selective debridement was performed on 3 separate ulcers, 3 ulcers of the distal legs; 2 are on the right leg and 1 is on the left leg. Depth and size of debridement is documented as 

  1. 15 sq cm, skin, subcutaneous tissue and muscle, right leg 

  2. 10 sq cm, skin, subcutaneous tissue and muscle, left leg 

  3. 10 sq cm, skin, subcutaneous tissue, muscle, and bone 

  

How is this reported? 

Answer:

Selective debridement of ulcer of the same depth are added together, regardless of their location. So, in the above scenario, the debridement of subcutaneous tissue and muscle are summed, for a total of 25 square centimeters. This is reported as codes, 11043 Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or and +11046 each additional 20 square cm or part thereof.  

The additional 10 square centimeter to a depth to bone are reported with code 11044, Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less.  

*This response is based on the best information available as of 3/14/24.

 
 
 
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General Surgery Joba Studio General Surgery Joba Studio

Denials for Initial Hospital Care and Observation E/M Codes: 2024 

We are experiencing denials when we bill 99221-99223 and the place of service is observation (outpatient hospital).  Are we doing something wrong?

Question:

We are experiencing denials when we bill 99221-99223 and the place of service is observation (outpatient hospital).  Are we doing something wrong?

Answer:

You are billing correctly based on CPT 2023 guidelines for E/M that merged inpatient hospital encounters/codes with observation encounters/codes.  Unfortunately, some payor claims processing systems may not yet recognize these changes as they apply to billing.  You will have to appeal these denied claims, with CPT references showing the current guidelines for E/M reporting.  

*This response is based on the best information available as of 2/29/24.

 
 
 
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General Surgery Joba Studio General Surgery Joba Studio

Modifiers with Unlisted Codes 

Can I use modifiers on an unlisted code?

Question:

Can I use modifiers on an unlisted code?

Answer:

In some circumstances, a modifier may be appropriately appended to an unlisted code. 

For example,  

  

  • CPT says, while uncommon, if multiple separately reportable unlisted codes are performed on the same patient on the same date by the same physician, multiple unlisted codes may be reported. If the two procedures are performed in the same anatomic region, then multiple units of the unlisted code may be reported with a modifier 59 

  • Modifier 62 (two surgeons/co-surgery) may also be appended to an unlisted code such as 64999 if co-surgery is documented.  

  • Modifier 58 for staged or more extensive procedures may also be appended to alert the payor to a second surgery during the global period, 

  • During the global period, it may also be appropriate (and recommended) to append global period modifiers such as 78 or 79 to an unlisted code to fully describe the surgical scenario to a payor. 

  

Do not append modifier 50 (bilateral procedure), modifier 51 or modifier 52 or 53 to an unlisted code. Your base, or comparison code, should reflect modifier 50 and the associated increase in fee. The same is true for modifier 22 

*This response is based on the best information available as of 2/15/24.

 
 
 
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General Surgery Joba Studio General Surgery Joba Studio

Coding Laparoscopic Liver Biopsy

Question:

How is a laparoscopic biopsy of the liver reported. Can we use code 47001, Biopsy of liver?

Answer:

47001 Biopsy of liver, needle; when done for indicated purpose at time of other major procedure (List separately in addition to code for primary procedure) may only be reported with an open procedure. See CPT Assistant 1992 below. If a laparoscopic biopsy of the liver is performed at the same time as another laparoscopic procedure, for example a laparoscopic cholecystectomy, report an unlisted code (47379). There is no CPT code for a laparoscopic liver biopsy.

*This response is based on the best information available as of 2/1/24.

 
 
 
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General Surgery General Surgery

Biopsy Procedure

What is the code for an open deep left inguinal node biopsy?

Question:

What is the code for an open deep left inguinal node biopsy?

Answer:

The correct CPT code 38531 Biopsy or excision of lymph node(s); open, inguinofemoral node(s) For biopsy or excision of the inguinofemoral (groin) nodes.

*This response is based on the best information available as of 12/28/23.

 
 
KZA - General Surgery - Coding Coach
 
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General Surgery General Surgery

Cholecystotomy Procedure

How should you code an open cholecystotomy, with a drain placement and a biopsy of the gallbladder wall is performed. Can the biopsy of the gallbladder be separately reported?

Question:

How should you code an open cholecystotomy, with a drain placement and a biopsy of the gallbladder wall is performed. Can the biopsy of the gallbladder be separately reported?

Answer:

No, the biopsy of the gallbladder wall is not separately reportable this is bundled and inclusive to the cholectstotomy. The correct code to report for this procedure would be CPT 47480,Cholecystotomy or cholecystostomy, open, with exploration, drainage, or removal of calculus (separate procedure).

*This response is based on the best information available as of 12/14/23.

 
 
KZA - General Surgery - Coding Coach
 
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