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Glossectomy Coding Help
I have a question about glossectomies. When coding a glossectomy what needs to be documented? My physician just states in the operative report he performed a glossectomy. Is that enough?
Question:
I have a question about glossectomies. When coding a glossectomy what needs to be documented? My physician just states in the operative report he performed a glossectomy. Is that enough?
Answer:
The answer to your question is no. Glossectomy codes (41120-41150) require removal of a portion or all of the tongue not just the lesion. You must document what portion or how much of the tongue is removed and tongue tissue removal. If only a lesion is removed see CPT code(s) 41112-41114.
*This response is based on the best information available as of 03/30/23.
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.
Costochondral Injection
We saw a patient who presented with chest pain and the physician diagnosed costal chondritis and the administered an injection into the costochondral junction. We are debating what CPT code to report for the injection? Is it 20550, 20600, 20605 or an unlisted code? We are considering CPT code 20600.
Question:
We saw a patient who presented with chest pain and the physician diagnosed costal chondritis and the administered an injection into the costochondral junction. We are debating what CPT code to report for the injection? Is it 20550, 20600, 20605 or an unlisted code? We are considering CPT code 20600.
Answer:
Thank you for your inquiry. This is not your typical orthopaedic injection! From a CPT coding perspective, the correct code is CPT code 20605 when Ultrasound Guidance is not a component of the service. The diagnosis is M94.0 (Chondrocostal junction syndrome).
Note: This advice is based on guidance from the AMA’s CPT Knowledge Base, revised in 2015 (KB #5189). The specific Q&A is available through AMA subscription.
Billing for an Iatrogenic Injury, Not my Patient (Stage 2)
My surgeon was called to the OR by an OB-GYN who accidently lacerated the bowel during an open gynecological procedure. She repaired the bowel with sutures. Should the diagnosis code be the same diagnosis as the reason for the primary surgery?
Question:
My surgeon was called to the OR by an OB-GYN who accidently lacerated the bowel during an open gynecological procedure. She repaired the bowel with sutures. Should the diagnosis code be the same diagnosis as the reason for the primary surgery?
Answer:
No. The diagnosis code for your surgeon would beK91.71 Accidental puncture and laceration of a digestive system organ or structure during other procedure.
*This response is based on the best information available as of 03/30/23.
Wound Debridement
What CPT code would you use for a wound debridement when the operative notes says the wound will heal by secondary intention. Do you use a repair code?
Question:
What CPT code would you use for a wound debridement when the operative notes says the wound will heal by secondary intention. Do you use a repair code?
Answer:
You would report a wound debridement code 1104X. The code selected would depend on anatomic location and total sq cm. You would not report a repair code. Secondary intention healing is when a wound is left open. No sutures or other materials are used to close the wound. Dressings are applied instead in order to protect the wound from contamination.
CP Angle vs Skull Base Codes
I just got a case where the neurosurgeon and ENT want to bill the following codes:
Question:
I just got a case where the neurosurgeon and ENT want to bill the following codes:
ENT, 61596, Transcochlear posterior fossa skull base code for the approach.
Neurosurgeon, 61616, intradural resection of a posterior fossa skull base tumor
Is this correct? The diagnosis is a right translabyrinthine approach to cerebellopontine angle and internal auditory canal with resection of vestibular schwannoma.
Answer:
CP angle tumors, for example vestibular schwannomas, treated via a translabyrinthine approach/exposure have a CPT code that specifically describes the work and value of this approach and resection. That code is61526, Craniectomy, bone flap craniotomy, transtemporal (mastoid) for excision of cerebellopontine angle tumor.The resection is essentially in the posterior fossa however, since it has a code specifically developed and valued for this procedure, code 61526 must be used. It is valued to reflect the work of this complex resection.
*This response is based on the best information available as of 03/30/23.
