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Component Seperation
Our provider has documented abdominal closure by component separation, is there a separate CPT code for this closure or is it included in the main procedure?
Question:
Our provider has documented abdominal closure by component separation, is there a separate CPT code for this closure or is it included in the main procedure?
Answer:
Component separation, sometimes referred to as a rectus advancement flap, refers to a myocutaneous flap of the trunk (a flap of subcutaneous tissue, fascia and muscle with an intact vascular supply) represented by CPT code 15734. To report this code the providers documentation must demonstrate that the oblique, transversalis or transverse abdominus and rectus abdominus muscles have been incised and mobilized toward the midline with an intact vascular supply. This code can be reported only once for each side and bilateral modifier does not apply, so when performed bilaterally report as 15734, 15734-59.
*This response is based on the best information available as of 10/3/24.
Documentation for Modifier 22
What documentation is needed to report modifier 22?
Question:
What documentation is needed to report modifier 22?
Answer:
To be able to append modifier 22 which represents an increased procedural service, the provider needs to demonstrate that the work required was substantially greater than normally expected. To support this, the documentation must provide more than a blanket statement and include details as to why the work was greater. For example: “extensive lysis of adhesions took greater than 90 mins prior to reaching (the intended site)”. The “what made it more work” is less crucial than the “details that explain why” it was more difficult so that payors will allow increased reimbursement.
*This response is based on the best information available as of 7/11/24.
Umbilical Hernia Repair with another Laparoscopic Procedure
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?
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
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?
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
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.
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
15 sq cm, skin, subcutaneous tissue and muscle, right leg
10 sq cm, skin, subcutaneous tissue and muscle, left leg
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
We are experiencing denials when we bill 99221-99223 and the place of service is observation (outpatient hospital). Are we doing something wrong?
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.