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Coding a Diverting Ileostomy with a Low Anterior Resection/Low Pelvic Anastomosis Partial Colectomy
Instead of a colostomy as described in the laparoscopic CPT codes 44208 or the open code, 44146, my doctor does a diverting ileostomy. We have been billing the primary codes 44145 or
Question:
Instead of a colostomy as described in the laparoscopic CPT codes 44208 or the open code, 44146, my doctor does a diverting ileostomy. We have been billing the primary codes 44145 or 44207 and adding the ileostomy code, 44187 if laparoscopic or 44310 if open. Is that correct?
Answer:
Partial colectomy with anastomosis and colostomy (codes 44146, open or 44208, laparoscopic) includes creation of a colostomy (stoma of the large intestine) or ileostomy (stoma of the small intestine). The clinical description of this code, written when the code was developed, describes either external opening, so the codes are valued to include either an ileostomy or colostomy. So the correct coding is 44146 or 44208 when a low anterior resection/low pelvic anastomosis partial colectomy and a diverting ileostomy is performed instead of a colostomy.
For more information on colorectal coding, take a look at the KZA webinarColorectal Surgery Coding and Reimbursement, or contact us for more information.
*This response is based on the best information available as of 6/11/20.
Billing Telehealth Post Op Visits
I am trying to find a resource that addresses telehealth billing in the post-operative period. Is it possible to bill a post-op follow-up telehealth video visit that is reimbursable
Question:
I am trying to find a resource that addresses telehealth billing in the post-operative period. Is it possible to bill a post-op follow-up telehealth video visit that is reimbursable in the post-operative/global period?
Answer:
If you are seeing the patient within the global period of a surgery performed by one of your surgeons, then a visit (in person or via telehealth) would only be billable if the visit was unrelated to the surgery. In other words, if a face-to-face post op visit wouldn’t be billable, then a telehealth post-op visit is not billable. If you are billing a 99024 for reporting purposes, then you do not need a modifier 95 and use place of service 11 or 22 should be used on the claim.
If you do have an unrelated diagnosis (not complication) for a visit within the global period (eg acute appendicitis during the global for a thyroidectomy), then you would bill the telehealth visit with a modifier 24 (along with any modifier to indicate telehealth – this varies by payor).
*This response is based on the best information available as of 4/30/20.
Coding for Non-Biological Mesh Placement
How do I report placement of a mesh implant in the abdomen that is not a biological implant and not for an open incisional hernia?
Question:
How do I report placement of a mesh implant in the abdomen that is not a biological implant and not for an open incisional hernia?
Answer:
Placement of a non-biological implant in the abdomen is reported with code +0437TImplantation of non-biologic or synthetic implant (eg, polypropylene) for fascial reinforcement of the abdominal wall (List separately in addition to code for primary procedure).It is an intraoperative procedure that may be performed with an intra-abdominal surgery to lessen the risk of incisional hernia by adding mesh.
*This response is based on the best information available as of 1/23/20.
Coding for ICG Imaging
Can you give guidance on CPT 15860 as it pertains to colorectal surgery?
Question:
Can you give guidance on CPT 15860 as it pertains to colorectal surgery?
My surgeons have been using this code when they use the isocyanine green fluorescence imaging either with the robot (Firefly) or open (SpyPhi). They are saying this code is relevant because they are assessing vascular flow in a graft (it’s technically a graft of autologous tissue to replace the removed bowel).
Answer:
The infusion of ICG dye as imaging to assess perfusion is inherent to the procedure and not separately reported.
*This response is based on the best information available as of 12/19/19.
Coding for Percutaneous Tracheostomy
What code is used for percutaneous tracheostomy?
Question:
What code is used for percutaneous tracheostomy?
Answer:
Code 31600 is reported for “percutaneous” tracheostomy. This procedure is performed with a small incision and some direct visualization of the structures with or without a bronchoscope. The bronchoscope, used as a light source and to remove blood and secretions, isNOTseparately reported.
*This response is based on the best information available as of 09/19/19.
Code +15777 for placement of a non-biologic implant. Is this the correct code?
I placed a non-biological implant for abdominal soft tissue reinforcement. Can this be coded as +15777?
Question:
I placed a non-biological implant for abdominal soft tissue reinforcement. Can this be coded as +15777?
Answer:
No. Code +15777 is reported specifically for abiological implantfor soft tissue reinforcement implant in breast or trunk only. Code +0437T, a Category III code, is reported for implantation of anonbiologic or synthetic implant(eg, polypropylene) for fascial reinforcement of the abdominal wall. A Category III code is intended as a temporary or tracking code, and payment is carrier determined. Payors may consider Category III codes to be investigational and therefore not covered. To increase chance of payment, have always have the procedure pre-authorized.
*This response is based on the best information available as of 08/22/19.