Umbilical Hernia Repair with another Laparoscopic Procedure

Question:

When our surgeon is performing a non-hernia laparoscopic procedure and a port is placed in the umbilicus, can we also code to repair a known asymptomatic umbilical hernia at the same time as the non-hernia laparoscopic procedure?

Answer:

No;  when a laparoscopic port is placed at the umbilical site, the repair of the umbilical hernia would be considered included and not separately reported. 

*This response is based on the best information available as of 620/24.

Breast Biopsies on Both Breasts – Same Session

Question:

Our breast surgeon performed biopsies (with a clip) on both the right and left breasts using ultrasound imaging. Do we code 19083 x 2 units since they are different breasts, or would we use 19083 and 19084 as the add-on code?

Answer:

If additional lesions (as you have described above) are biopsied in the contralateral breast using the same imaging, report the primary code and the add-on code for the second lesion. If more than one lesion is biopsied, using different imaging modalities, report the appropriate primary code for each.

*This response is based on the best information available as of 4/11/24.

Selective Debridement of Multiple Ulcers

Question:

Selective debridement was performed on 3 separate ulcers, 3 ulcers of the distal legs; 2 are on the right leg and 1 is on the left leg. Depth and size of debridement is documented as 

1. 15 sq cm, skin, subcutaneous tissue and muscle, right leg 

2. 10 sq cm, skin, subcutaneous tissue and muscle, left leg 

3. 10 sq cm, skin, subcutaneous tissue, muscle, and bone 

How is this reported? 

Answer:

Selective debridement of ulcer of the same depth are added together, regardless of their location. So, in the above scenario, the debridement of subcutaneous tissue and muscle are summed, for a total of 25 square centimeters. This is reported as codes, 11043 Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or and +11046 each additional 20 square cm or part thereof.  

The additional 10 square centimeter to a depth to bone are reported with code 11044, Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less.  

*This response is based on the best information available as of 3/14/24.

Denials for Initial Hospital Care and Observation E/M Codes: 2024

Question:

We are experiencing denials when we bill 99221-99223 and the place of service is observation (outpatient hospital).  Are we doing something wrong?

Answer:

You are billing correctly based on CPT 2023 guidelines for E/M that merged inpatient hospital encounters/codes with observation encounters/codes.  Unfortunately, some payor claims processing systems may not yet recognize these changes as they apply to billing.  You will have to appeal these denied claims, with CPT references showing the current guidelines for E/M reporting.  

*This response is based on the best information available as of 2/29/24.

Modifiers with Unlisted Codes

Question:

Can I use modifiers on an unlisted code?

Answer:

In some circumstances, a modifier may be appropriately appended to an unlisted code. 

For example,  

• CPT says, while uncommon, if multiple separately reportable unlisted codes are performed on the same patient on the same date by the same physician, multiple unlisted codes may be reported. If the two procedures are performed in the same anatomic region, then multiple units of the unlisted code may be reported with a modifier 59 

• Modifier 62 (two surgeons/co-surgery) may also be appended to an unlisted code such as 64999 if co-surgery is documented.  

• Modifier 58 for staged or more extensive procedures may also be appended to alert the payor to a second surgery during the global period, 

• During the global period, it may also be appropriate (and recommended) to append global period modifiers such as 78 or 79 to an unlisted code to fully describe the surgical scenario to a payor. 

Do not append modifier 50 (bilateral procedure), modifier 51 or modifier 52 or 53 to an unlisted code. Your base, or comparison code, should reflect modifier 50 and the associated increase in fee. The same is true for modifier 22 

*This response is based on the best information available as of 2/15/24.

Coding Laparoscopic Liver Biopsy

Question:

How is a laparoscopic biopsy of the liver reported. Can we use code 47001, Biopsy of liver?

Answer:

47001 Biopsy of liver, needle; when done for indicated purpose at time of other major procedure (List separately in addition to code for primary procedure) may only be reported with an open procedure. See CPT Assistant 1992 below. If a laparoscopic biopsy of the liver is performed at the same time as another laparoscopic procedure, for example a laparoscopic cholecystectomy, report an unlisted code (47379). There is no CPT code for a laparoscopic liver biopsy.

*This response is based on the best information available as of 2/1/24.