Coding a Colectomy with Diverting Ileostomy

Question:

How is a partial colectomy with diverting ileostomy coded? The partial colectomy codes say “with colostomy”.

Answer:

Thank you for asking. We have recently revised the recommendation for this procedure based on new information. It is appropriate to use codes that say “with colostomy” (for example, 44141, 44146, 44208) when a diverting ileostomy is performed instead of a colostomy. When these codes were originally valued the codes were valued foreither acolostomy or an ileostomy.

*This response is based on the best information available as of 01/19/17.

CPT Coding for Converting to an Open approach

Question:

My doctor started a laparoscopic cholecystectomy that had to be converted to open due to significant adhesions. He documented both approaches and the laparoscopic approach took significant time before he had to convert to open. Can both be billed?

Answer:

Unfortunately, no. Whenever a “closed” procedure (laparoscopic, arthroscopic, endovascular) is converted to an open procedure only the open procedure may be reported. If a significant amount of time was spent attempting the closed procedure, and this is documented, a 22 modifier for increased procedural services may be appended to the open code. Don’t forget to add the appropriate diagnostic code to indicate the conversion. See the appropriate diagnosis codes below.

• Z53.31 Laparoscopic procedure converted to open

• Z53.32 Thoracoscopic procedure converted to open

• Z53.33 Arthroscopic procedure converted to open

• Z53.39 Other specific procedure converted to open

*This response is based on the best information available as of 10/27/16.

Billing for Bravo Placement

Question:

How do I bill for the Bravo placement? I’m coding an EGD with 43235 and the Bravo code, 91035 but getting denied.

Answer:

Great question and one that came up at a recent ACS coding course! First, if endoscopy is performed to evaluate the underlying problem, this is coded as a diagnostic EGD endoscopy, 43235. If something therapeutic is performed during the endoscopy, for example a biopsy, the appropriate therapeutic endoscopy code would be reported. The Bravo capsule code, 91035 Esophagus, gastroesophageal reflux test with mucosal attached pH electrode placement, recording, analysis and interpretation, should be reported and the date Bravo capsule is removed a few days after placement. Also, if an EGD for diagnostic or therapeutic purposes was done previously and already diagnosed the problem, it would not be appropriate to report it with a subsequent Bravo placement.

*This response is based on the best information available as of 09/01/16.

Coding Lymph Node Excision, Biopsy and Lymphadenectomy

Question:

During a lumpectomy, if the results of an axillary lymph node excision and biopsy (38525) lead to an axillary lymphadenectomy (38745), are both codes reported in addition to 19301, the lumpectomy?

Answer:

No, a lumpectomy with a deep axillary lymphadenectomy is reported with a single code, 19302, Mastectomy, partial (e.g., lumpectomy, tylectomy, quadranectomy, segmentectomy); with axillary lymphadenectomy. This code is valued for the lumpectomy and the axillary lymphadenectomy. The excision of lymph nodes for biopsy, 38525, is not separately reported as it is included in the total lymphandectomy.

*This response is based on the best information available as of 06/23/16.

On-Q Pain Pump Coding

Question:

My doctor repaired an inguinal hernia and also placed On-Q pain pumps. Can these be billed with an unlisted code?

Answer:

Good Question:! Any pain management provided by the operating surgeon, including placing On-Q pain pump, is part of the global package and not separately reported.

*This response is based on the best information available as of 03/03/16.

Coding Incomplete Colonoscopies

Question:

Which code would be appropriate to report45330, Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) or45378, Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure), if the physician is unable to advance the colonoscope to the cecum?

Answer:

Per CPT guidelines, if the colonoscopy was a screening or diagnostic colonoscopy, CPT code45378would be reported with modifier 53, Discontinued Procedure. This indicates that a diagnostic or screening was not complete to the cecum. If the colonoscope does not reach the splenic flexure, a sigmoidoscopy, code45330, would be reported.

If the colonoscopy was therapeutic and it is not complete to the cecum, the appropriate therapeutic colonoscopy code is reported with a 52 modifier.

Refer to the decision tree in the CPT Professional codebook.

*This response is based on the best information available as of 12/03/15.