Coding a Skin or Nipple Sparing Mastectomy

Question:

What is the appropriate code for a complete skin sparing or complete nipple sparing mastectomy?

Answer:

The code for a mastectomy described as complete skin sparing or complete nipple sparing mastectomy is 19303.

*This response is based on the best information available as of 04/19/18.

Right Colectomy and Small Bowel Resection

Question:

The surgeon did a right colectomy and also documented a resection of the ileum. Is this billed separately as a small bowel resection?

Answer:

No. The resection of the ileum and anastomosis of the new end of the ileum (the neoterminal ileum) to the remaining colon (an ileocolostomy) is included in the code; 44160 for open and 44205 if performed laparoscopically.

*This response is based on the best information available as of 03/29/18.

Breast Cyst Aspiration

Question:

The surgeon did a fine needle aspiration of two cysts in the same breast without any imaging. Is this billed once or twice?

Answer:

Fine needle aspiration of a breast cyst is reported per cyst. In this scenario, code 10021 with 2 units or 10021 and a second 10021 with a 59 or XS modifier as directed by your payor.

The fine needle aspiration codes are shown below.

Fine Needle Aspiration (FNA)

CPT Code	Description
10021	Fine needle aspiration; without imaging guidance
10022	with imaging guidance

Global Period for both codes – XXX*XXX means the concept of global period does not apply

*This response is based on the best information available as of 02/01/18.

Laparoscopic Pyloroplasty Coding

Question:

How is a laparoscopic pyloroplasty reported?

Answer:

There is no current CPT code laparoscopic pyloroplasty, only an open code. An open code may not be used if a procedure is done laparoscopically. An unlisted code must be used. In this case, use code 43659, unlisted laparoscopic procedure, stomach.

*This response is based on the best information available as of 01/18/18.

Billing an Appendectomy with Another Surgery

Question:

Is an appendectomy separately reported when done with another abdominal procedure?

Answer:

If the appendectomy is performed for a medically indicated purpose, for example the appendix was involved in the disease process, it can be reported with an add-on code, +44955. See the description of this code below. No modifier would be appended to this code and you should expect 100% reimbursement since add-on codes are valued lower since they are always reported with another procedure.

44955: Appendectomy; when done for indicated purpose at time of other major procedure (not as separate procedure) (List separately in addition to code for primary procedure

*This response is based on the best information available as of 01/04/18.

Coding an Omental Flap

Question:

Can add-on code 49905 (omental flap) be  reported for buttressing an incision or anastomosis?  For example after a colectomy?  Or is the intent of the code, reconstruction of a defect only.

49905 Omental flap, intra-abdominal (List separately in addition to code for primary procedure)

Answer:

No, buttressing a formed anastomosis (made by staples or sutures) with extra suture, mesenteric fat, or even fibrin sealant is all considered inherent to the creation of that anastomosis and would not be separately reported.

*This response is based on the best information available as of 11/16/17.