Craniosynostosis Co-surgery Question

Question:

We have a new plastic surgeon who will start doing craniosynostosis surgery with a pediatric neurosurgeon. Will this be co-surgery using modifier 62?

Answer:

Potentially yes. It will depend on which surgeon does what part of the procedure. All the craniosynostosis codes (61550 – 61559) accept modifier 62 so if both the plastic surgeon and neurosurgeon do different parts of that CPT code then modifier 62 would be appropriate. If the plastic surgeon does other work such as orbital advancement then the plastic surgeon may separately report that code(s) which might not be co-surgery. It’s going to all depend on the documentation.

E/M Visit During the Global Period

Question:

Can I bill an office visit in the global period if the diagnosis is different from why I did the original procedure?

Answer:

Yes, as long as the diagnosis is not for a related issue (e.g., complication from the original procedure). The documentation must be clear that the condition is unrelated to the original procedure and reflect a clear plan of treatment for the new/unrelated issue. You will then append modifier 24 (unrelated E/M in a global period) to the E/M code.

Skin Lesion Excision – Wait for Pathology?

Question:

I’ve heard you say to wait for the pathology report in order to bill for the skin lesion excision codes 114xx (benign) and 116xx (malignant)? What if I have a biopsy report – do I still need to wait?

Answer:

Good question – no you do not need to wait if you have a biopsy pathology report showing a malignancy for that lesion. You can go ahead and use the malignant diagnosis and CPT codes for the excision.

Bilateral Carpal Tunnel Procedures – Different Days

Question:

We are going to be doing bilateral carpal tunnel procedures on a patient – the right side will be done first then the left will be done 8 weeks later. Should I use modifier 58 (staged procedure) on the 2nd procedure?

Answer:

Actually, it’s best to use modifier 79 (unrelated procedure in a global period) because the left side (2nd procedure) is unrelated to the right side (1st procedure). Be sure to use the laterality specific ICD-10-CM codes – G56.01 (Carpal tunnel syndrome, right upper limb) and G56.02 (Carpal tunnel syndrome, left upper limb) – for the respective procedures.

Takeback to OR

Question:

I had to take a patient back to the operating room 6 weeks after breast reduction to excise a small dehiscence and close the wound. Can I bill for this?

Answer:

Yes, you may bill for the service and you’ll need to use modifier 78 (return to the OR for a related procedure) on your billed code(s). Most payors will reduce your payment by a small percentage (20 – 30%) but you’ll stay in the same 90-day postoperative global period as the breast reduction procedure.

Spinal Wound Closure with Flaps

Question:

One of our spine surgeons has asked me to help with an upcoming case. The patient is obese and has had multiple prior spine procedures. The spine surgeon would like me to close using bilateral paraspinal muscle flaps. How do I code the procedure and will I even get paid?

Answer:

Good question because some closure is included in the spine procedure codes. The type of closure included in most surgical procedure codes is classified as simple, intermediate or complex repairs. Simply put, bringing the wound edges together directly is included in surgical procedure codes (except excision of skin lesion codes). You’re doing more than bringing the wound edges together so you are allowed to code for the procedure and you should be paid. You’ll use 15734 for one side and 15734-59 for the contralateral side.