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Choosing a Modifier with a Colostomy Revision
What modifier is used to report a colostomy revision during the global period of the stoma creation?
Question:
What modifier is used to report a colostomy revision during the global period of the stoma creation?
Answer:
A modifier 78, return to the OR for a related procedure, in this case a complication of the creation, would be appended.
*This response is based on the best information available as of 09/22/22.
Coding Mesh Placement in Hernia Repairs
If mesh is placed for a laparoscopic hernia repair can an unlisted code be reported for the mesh placement?
Question:
If mesh is placed for a laparoscopic hernia repair can an unlisted code be reported for the mesh placement?
Answer:
No. All laparoscopic hernia repair codes include mesh placement so it would not be appropriate to bill for mesh separately.
*This response is based on the best information available as of 09/08/22.
Billing for Intraoperative Injury
A major blood vessel was accidentally nicked while a general surgeon was performing a complex case. A vascular surgeon was called in to repair the blood vessel. Since they are different specialties, can the vascular surgeon bill for the repair, even though she is in the same group as the general surgeon?
Question:
A major blood vessel was accidentally nicked while a general surgeon was performing a complex case. A vascular surgeon was called in to repair the blood vessel. Since they are different specialties, can the vascular surgeon bill for the repair, even though she is in the same group as the general surgeon?
Answer:
Yes, if both surgeons are different specialties and designated with separate taxonomy number (General Surgery and Vascular Surgery are) then the vascular surgeon should bill for the repair.
*This response is based on the best information available as of 08/25/22.
Use of Modifier 52
My surgeon was called into a laparoscopic operation that was already underway, to perform extensive lysis of adhesions. Does he need to use a modifier 52 because the patient was already “opened”, or can we just bill for 44180 Laparoscopic lysis of adhesions?
Question:
My surgeon was called into a laparoscopic operation that was already underway, to perform extensive lysis of adhesions. Does he need to use a modifier 52 because the patient was already “opened”, or can we just bill for 44180 Laparoscopic lysis of adhesions?
Answer:
You would bill for 44180 without a modifier 52, as the surgeon performed the entirety of the procedure listed.
*This response is based on the best information available as of 08/11/22.
Separate Procedure Billing
The surgeon performed an open colectomy and found a tear in the mesentery close to the incision, 44850 Suture of mesentery is listed as a “separate procedure”, does that mean we can bill for it separately in addition to the colectomy?
Question:
The surgeon performed an open colectomy and found a tear in the mesentery close to the incision, 44850 Suture of mesentery is listed as a “separate procedure”, does that mean we can bill for it separately in addition to the colectomy?
Answer:
No, codes designated as a “separate procedure” are intended to identify procedures that are only reported if they are the only procedure performed in that anatomic area. When performed with a more comprehensive procedure in the same anatomic area, only the more comprehensive procedure is reported. In your example, only the colectomy would be reported.
*This response is based on the best information available as of 07/28/22.
Billing for Reopening of Recent Laparotomy
Our surgeon insists on billing for 49002 reopening of a recent laparotomy and a 44005 lysis of adhesions, since the case is complicated because the laparotomy was only 60 days ago. Can he bill for both in any circumstance?
Question:
Our surgeon insists on billing for 49002 reopening of a recent laparotomy and a 44005 lysis of adhesions, since the case is complicated because the laparotomy was only 60 days ago. Can he bill for both in any circumstance?
Answer:
Although this was a reopening of a recent laparotomy, lysis of adhesions was the primary procedure performed and would be the only code billable. Coding rules would follow the same guidelines for 49002 just as they do for an exploratory laparotomy 49000. When a more extensive procedure is performed, the laparotomy (in this case reopening of a laparotomy) is not separately billable. And don’t forget to add the appropriate modifier depending on the circumstance, to indicate whether the surgery was related, for example a complication, (78), an intentionally staged procedure (58) or if unrelated (79) to the original laparotomy.
*This response is based on the best information available as of 07/14/22.