Tag Archives: Incision
64704 Denials? 5 ways to Fix Your Neuroplasty Claims
If you’re just plodding though nerve surgery claims, you could be stepping over a great deal of well-earned reimbursement. Coding and billing peripheral nerve surgeries for conditions such as tarsal tunnel and diabetic neuropathy can involve a frazzling number of codes. Podiatry coders often struggle to navigate the various coding guidelines that payers use for these procedures. Use these five tips to maximize payment for your podiatrist’s hard work on nerve surgeries:
Tip 1: Check CCI edits and your local Medicare guidelines
If you’re billing codes that the Correct Coding Initiative bundles together — and your documentation and diagnosis codes can’t justify breaking the bundle — you’re not going to see one extra cent for that bundled procedure code.
Example: A California Medicare patient injures his foot when he falls off a ladder and requires peripheral nerve surgery to correct the damage the injury caused. The podiatrist performs the following:
28035 — Release, tarsal tunnel (posterior tibial nerve decompression)
64712 — Neuroplasty, major peripheral nerve, arm or leg, open; sciatic nerve
64704 — Neuroplasty; nerve of hand or foot
+64727 — Internal neurolysis, requiring use of operating microscope (List separately in addition to code for neuroplasty) (Neuroplasty includes external neurolysis)
64708 — Neuroplasty, major peripheral nerve, arm or leg, open; other than specified.
If you report all these codes, you’re bound to get a denial on 64704 — this is one of the codes the Correct Coding Initiative (CCI) bundles into 28035. Unless you can justify billing 64704 separately (and if that’s the case, append modifier 59, Distinct procedural service, to the code), you shouldn’t list it all.
Unbundling is not automatic: Be aware that you can’t automatically override a CCI edit with modifier 59 just because documentation supports a separate site,…
10120 or Beyond: Site, Depth, Complexity Drive Códe Choice
Follow 3 pointers to snag maximum pay.
From just under the skin to deep within the bowels, your general surgeon might perform a foreign body removal (FBR) that calls on a wide range of coding know-how. Zero in on the right codè every time by implementing these four principles:
1. Use 10120-10121 for Any Site Under Skin
If your surgeon makes an opening to remove any foreign body, such as a glass shard or a metal filing, but doesn’t indicate an anatomic site or depth in the op report, you’ll probably choose 10120 (Incision and removal of foreign body, subcutaneous tissues; simple). You can’t choose a more specific codè if the surgical report doesn’t provide any more documentation.
Caveat: Because the codè requires incision, look for a sharp object when considering 10120. If the documentation doesn’t include this detail, use an E/M service codè (such as 99201-99215, Office or Other Outpatient Services) instead of the skin FBR codè.
Look for complications: If the surgeon uses the term “simple” in the op note or fails to note any extenuating circumstances, you’re good to go with 10120. But the surgeon might perform a complicated FBR, meaning that the foreign body was harder than usual to remove. In these situations, the note should indicate, for example, extended exploration around the wound site, presence of a complicating infection, or sometimes the need to use visualization and localization techniques, such as x-ray. In those cases, you should choose 10121 (… complicated) for a subcutaneous FBR with no mention of anatomic site.
2. Search Musculoskeletal Codè for Specific Site
CPT® contains higher-paying FBR codè s than 10120-10121, but the surgeon needs to document the following two details before you can use the codès:
Location: You’ll find myriad FBR codès scattered throughout CPT®’s “Musculoskeletal System” section (20000-29999),…
Know the Types of Graft
Question: What’s the difference between a spinal allograft and an autograft?
Answer: If the surgeon harvests bone from the patient’s own body, you’ll code for an autograft with one of the following codes:
+20936 — Autograft for spine surger… Continue reading
37228-+37235 Cover Your Tibial/Peroneal Service Codes
Facing denials on your tibial/peroneal codes? No worries, help is at hand.
The new tibial/peroneal service codes are below. Note that all of the codes include angioplasty in the same vessel when that service is performed.
The first four codes apply to the initial tibial or peroneal vessel treated in a single leg:
- Angioplasty: 37228 — Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal angioplasty
- Atherectomy (and angioplasty): 37229 — … with atherectomy, includes angioplasty within the same vessel, when performed
- Stent (and angioplasty): 37230 – … with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
- Stent and atherectomy (and angioplasty): 37231 — … with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed.
The final four codes are add-on codes that you use to report services on each additional ipsilateral (same side) vessel treated in the tibial/peroneal territory:
The general rule for the revascularization codes is that you should report the one code that represents the most intensive service performed in a single lower extremity vessel. All lesser services in that vessel are included in that one code.
Note that CPT guidelines state that –” in addition to the intervention performed –” the codes include:
- Accessing the vessel
- Selectively catheterizing the vessel
- Crossing the lesion
- Radiological supervision and interpretation for the intervention performed
- Any embolic protection used
- Closure of arteriotomy (incision in the artery)
- Imaging performed to document the intervention was completed.
But remember that if the physician performs mechanical thrombectomy (such as 37184-+37185, primary, or +37186, secondary), thrombolysis (such as 37201, 75896), or both, to help restore blood flow to the occluded area, CPT states you may report those services separately.
The new revascularization codes (37220-+37235) apply to different “territories.” Each…
37228-+37235 Cover Your Tibial/Peroneal Service Codes
Facing denials on your tibial/peroneal codes? No worries, help is at hand.
The new tibial/peroneal service codes are below. Note that all of the codes include angioplasty in the same vessel when that service is performed.
The first four codes apply to the initial tibial or peroneal vessel treated in a single leg:
- Angioplasty: 37228 — Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal angioplasty
- Atherectomy (and angioplasty): 37229 — … with atherectomy, includes angioplasty within the same vessel, when performed
- Stent (and angioplasty): 37230 – … with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
- Stent and atherectomy (and angioplasty): 37231 — … with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed.
The final four codes are add-on codes that you use to report services on each additional ipsilateral (same side) vessel treated in the tibial/peroneal territory:
The general rule for the revascularization codes is that you should report the one code that represents the most intensive service performed in a single lower extremity vessel. All lesser services in that vessel are included in that one code.
Note that CPT guidelines state that –” in addition to the intervention performed –” the codes include:
- Accessing the vessel
- Selectively catheterizing the vessel
- Crossing the lesion
- Radiological supervision and interpretation for the intervention performed
- Any embolic protection used
- Closure of arteriotomy (incision in the artery)
- Imaging performed to document the intervention was completed.
But remember that if the physician performs mechanical thrombectomy (such as 37184-+37185, primary, or +37186, secondary), thrombolysis (such as 37201, 75896), or both, to help restore blood flow to the occluded area, CPT states you may report those services separately.
The new revascularization codes (37220-+37235) apply to different “territories.” Each…
52300 or No 52300 For Ureterocele?
Question: My urologist performed a cystoscopy, transurethral incision of an orthotopic ureterocele, ureteroscopy, and a double J stent placement. I have drawn a blank on how to report the ureterocele incision. Here is the doctor’s note: “A 24 resec… Continue reading
Look for Incision Evidence in Foreign Body Removal (FBR) Scenarios
Here’s why you should append modifier 25.
Question: A 47-year-old male reports to the ED complaining of a painful, swollen, and reddening right thumb. The physician performs an expanded problem focused history and examination, which uncovers two splinters. The ED…
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