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Foreign Body Removal
A patient had a craniotomy a week ago and the provider is doing a removal of a retain drain of post op wound in the operating room. What is the best code to use 10120?
Question:
A patient had a craniotomy a week ago and the provider is doing a removal of a retain drain of post op wound in the operating room. What is the best code to use 10120?
Answer:
The best code is 10121, incision and drainage of foreign body, complex, since this required a return to the OR and was done for retained cranial drain. Remember to add a 78 modifier, for a return to the OR.
*This response is based on the best information available as of 12/01/22.
Oral Food Challenge
What needs to be documented to support billing CPT code 95076/95079?
Question:
What needs to be documented to support billing CPT code 95076/95079?
Answer:
Complete documentation is critical for oral challenges. Be sure to document:
- Time testing begins and ends
- The amount of food or drug given
- Any adverse reactions
- Discussion of test results
*This response is based on the best information available as of 12/01/22.
Coding for Trauma Resuscitation
How do we bill for a trauma resuscitation? Are there codes for hanging fluids and packed cells? Can we use the CPR code 92950?
Question:
How do we bill for a trauma resuscitation? Are there codes for hanging fluids and packed cells? Can we use the CPR code 92950?
Answer:
There is no specific code for a trauma resuscitation or for administering fluids or blood products. The CPR code is specifically for providing cardiopulmonary resuscitation; chest compression, airway support. Trauma resuscitation is best reported with a critical care code.
*This response is based on the best information available as of 12/01/22.
2021 E/M Coding Guidelines
In the 2021 E/M revision guidelines, how does Time affect billing for a teaching physician’s E/M service when the resident spends a great deal of time with the patient?
Question:
In the 2021 E/M revision guidelines, how does Time affect billing for a teaching physician’s E/M service when the resident spends a great deal of time with the patient?
Answer:
Good question! Only the time of teaching physician would “count” in the scenario you describe. The new guidelines say that the time of the physician or other qualified health care provider (QHP) are considered. A QHP is a licensed credential provider of E/M services such as a Physician Assistant, Nurse Practitioner or Clinical Nurse Specialist…not a resident. Therefore, we cannot add, or consider, the amount of time the resident spent with the patient.
Secondary Payor Doesn’t Recognize Consultations
We have a patient with 2 commercial payers (BCBS and Cigna). A consultation code was submitted to BCBS, and they paid according to our contract. However, Cigna is refusing to process the claim since they no longer pay for consult codes. Am I allowed to change the CPT code and rebill Cigna? Or would I need to change the CPT, refile to the primary as a corrected claim, then send the balance on to Cigna?
Question:
We have a patient with 2 commercial payers (BCBS and Cigna). A consultation code was submitted to BCBS, and they paid according to our contract. However, Cigna is refusing to process the claim since they no longer pay for consult codes. Am I allowed to change the CPT code and rebill Cigna? Or would I need to change the CPT, refile to the primary as a corrected claim, then send the balance on to Cigna?
Answer:
We suggest calling CIGNA and ask how they want this handled according to their policies. WithMedicareyou have two options: (1) bill the appropriate category and level of service documented (e.g., for outpatient consults [99202-99215] or inpatient consults [99221-99223]) or (2) bill the consultation code, which will result in a denial of payment from Medicare and appeal on paper explaining the situation.
Excisional Biopsy
My physician is insisting that I bill an excision biopsy using a punch as a punch biopsy (11104). The documentation says the lesion was removed in its entirety. Is this a biopsy of lesion excision. She does not document the cm size of the removal.
Question:
My physician is insisting that I bill an excision biopsy using a punch as a punch biopsy (11104). The documentation says the lesion was removed in its entirety. Is this a biopsy of lesion excision. She does not document the cm size of the removal.
Answer:
Skin biopsy procedures can be grouped by how much of the lesion is removed. If you have an excisional biopsy, the entire lesion is removed. Examples of excisional biopsy procedures include elliptical excision, deep scoop shave, and punch biopsy for small lesions. Codes should be reported with the excision codes 11400-11471 (benign lesions) or 11600-11646 (malignant lesions). The practice should wait for the pathology report for correct coding. The physician should document the anatomic location, method of removal and cm size at a minimum.