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Abdominal Fat Pad Core Biopsy
We did an abdominal fat pad biopsy for primary cutaneous Amyloidosis. Would 49180 or 11104 be the appropriate code for this?
Question:
We did an abdominal fat pad biopsy for primary cutaneous Amyloidosis. Would 49180 or 11104 be the appropriate code for this?
Answer:
49180 is for a core sample within or behind the abdominal cavity. If the core biopsy is documented down to the subcutaneous fat pad only, this is coded as a punch biopsy 11104. And if the provider documents ultrasound guidance with proper documentation (i.e., noting anatomical findings and needle placement), 76942 can be billed as well with modifier 26 if indicated.
*This response is based on the best information available as of 9/17/20.
Coding a Hand Assisted Laparoscopy
The surgeon described the procedure as a ‘hand assisted laparoscopy” He brought part of the bowel outside of the body for evaluation. Does this convert the procedure to open?
Question:
The surgeon described the procedure as a ‘hand assisted laparoscopy” He brought part of the bowel outside of the body for evaluation. Does this convert the procedure to open?
Answer:
Mobilizing the bowel outside the body (extracorporeally) during a laparoscopic procedure does not convert the procedure to open, it is still consider a laparoscopic procedure and coded as laparoscopic.
*This response is based on the best information available as of 9/3/20.
Hartmann or Partial Colectomy
My surgeon performed all the components of a Hartmann procedure 44143 but did not create a colostomy. Can we use 44143 with a -52 modifier?
Question:
My surgeon performed all the components of a Hartmann procedure 44143 but did not create a colostomy. Can we use 44143 with a -52 modifier?
Answer:
The correct code for this procedure would be 44140. Code 44140 is the base code for 44143 with the only difference being a skin level colostomy, so it would be inappropriate to code 44143-52 as there is an established code already in place.
*This response is based on the best information available as of 8/6/20.
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.