How do you report bilateral procedures? One line or two?October 14th, 2009 - Mary LeGrand
Bilateral Total Knees—How to Submit the Claim From
How do I report bilateral procedures, one line or two?
Great question, unfortunately the payors have made this simple concept of bilateral procedures challenging from a reimbursement standpoint! Survey your payors...Transphenoidal hypophysectomy--how is this coded?August 10th, 2009 - Kim Pollock
How do we code a transphenoidal hypophysectomy when we do the procedure with an ENT doctor? The ENT doctor says he has his own codes to bill.
There are two codes to report this procedure. First, CPT® 61548 (Hypophysectomy or excision of pituitary tumor, transnasal or...Assistant surgeonJuly 19th, 2009 - Codapedia Editor
Some surgical procedures may be performed with both a primary surgeon and an assistant surgeon. Insurance companies typically pay 20% to 25% for the assistant. Medicare allows 16% of the full fee payment for the assistant surgeon.What is an Incomplete Colonoscopy?June 12th, 2009 - Alyce Kalb
A complete colonoscopy according to Current Procedural Terminology published by the AMA is:
“Colonoscopy, flexible, proximal to the splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate...LipomaMay 11th, 2009 - Codapedia Editor
From the Q&A section:
I have a patient with a large (~15 cm) soft tissue mass in his flank which on initial evaluation is consistent with a large lipoma (95% sure, but I've been tricked with sarcomas before). For the excision, would I use the skin code (11406) or the...Laparoscopic procedure without a codeMay 11th, 2009 - Codapedia Editor
Do not use the open code for procedure when performing the service laparoscopically. Use an unlisted code if none exists. Contact your medical society and the CPT® committee to describe the service and advocate for a code.
Here is Nancy Maguire's response to this question on the Q&A...How to submit a question to CPT® Assistant/AMA?April 3rd, 2009 - Christina Benjamin
1. As a CPT® Assistant subscriber, if you have a question that is directly
related to CPT® Assistant, they will answer it. Questions can be e-mailed to firstname.lastname@example.org with subject - call for letters and to attention of Gloria Green per the CPT® Assistant. They ask that...Using Modifer -59March 31st, 2009 - Crystal Reeves
By Crystal Reeves, CPC, CMPE, Principal
Modifier -59 is probably one of the most misunderstood, misused, and most-feared of all CPT® modifiers. Some practices avoid using it all together because they don’t want to be guilty of unbundling. Some practices do not use it because they are not...Suture removalMarch 30th, 2009 - Codapedia Editor
If a physician removes sutures that he/she placed, and the service has a ten day global period, there is no separate payment for the suture removal. It is part of the global service and payment for the minor procedure.
However, insurance companies will pay for suture removal performed by a...Global Surgical PackageMarch 29th, 2009 - Codapedia Editor
The concept of paying surgeons a global payment for all services related to a surgery started in 1992, with the implementation of the Resource Based Relative Value System (RBRVS). This concept describes the components of the global package, and established the post op period for surgical services,...Modifier 58March 25th, 2009 - Codapedia Editor
Modifier 58 is appended to a surgical service to indicate that the physician performed a procedure during the global period that was planned at the time of the original procedure (staged), was more extensive than the original procedure, or is the therapeutic service following a diagnostic procedure....Modifier 78March 25th, 2009 - Codapedia Editor
Modifier 78 is used to indicate that the physician who performed a surgery which had a 10 or 90 day global period took the patient back to the OR for a related problem, typically, a complication. Do not use it for staged or related procedures--that is reported using modifier 58. For unrelated...Modifier 79 Unrelated procedure or serviceMarch 25th, 2009 - Codapedia Editor
Modifier 79 is appended to a procedure to indicate that the same surgeon took the patient back to the operating room during the global surgical period for an unrelated problem. The second procedure must be unrelated to the original procedure. See modifier 78 for return trips to the OR that are...Modifier 77March 25th, 2009 - Codapedia Editor
Modifier 77 is used to indicate that the same procedure was performed on a patient, but the service was done by a different physician than the first procedure. Use this modifier on the same day or during the global period of the first service.
Use the same CPT® code.
The procedure report...Modifier 76 Repeat Procedure or Service by Same PhysicianMarch 25th, 2009 - Codapedia Editor
Modifier 76 is used to report the service when the same procedure is performed by the same physician, on the same patient either the same day of the previous procedure or doing the global period. The modifier tells the payer that this is not a duplicate bill, but that the same procedure was...Modifier 54 and modifier 55March 21st, 2009 - Codapedia Editor
The global surgical package includes the care of the patient pre-operatively, intra-operatively and post-operatively. In some cases, however, the surgeon has performed only part of those services. For example, a tourist at a ski resort who falls and requires surgery will return to their own home...Modifier 79March 18th, 2009 - Codapedia Editor
Modifier 79 is used to indicate that the physician performed a surgical service that required a return trip to the OR for an unrelated problem during the global post op period. Modifier 79 is appended to procedures. See the CPT® book for the complete definition. It is appended when:
A...Modifier 57March 18th, 2009 - Codapedia Editor
Modifier 57 is a modifier that is appended to an E/M service to indicate that this was the visit at which the physician decided to perform surgery. It is only used on procedures with a 90 day global period, per CMS, although this is not a CPT® rule. It is only used the day of or before a major...Two surgeons operating on the same patient, same sessionMarch 18th, 2009 - Codapedia Editor
Most surgeries with two surgeons are reported and performed as the primary surgeon (no modifier on the CPT® code) and the assistant surgeon (modifiers 80, 81, 82, and AS). Some surgeries, however, require two surgeons (modifier 62) or a surgical team (modifier 66). How does a physician or...Skin tag removalMarch 10th, 2009 - Codapedia Editor
Many physicians report that it is difficult to get insurance companies to pay for skin tag removal. That is because most insurances consider the service to be cosmetic. If you are performing the service, tell the patient prior to providing the service that if their insurance determines the...Using modifier 66 (team surgery) Q&AMarch 4th, 2009 - Mary LeGrand
Multiple Surgeons, Different Procedures
Do I use modifier 66 (team surgery) when our General surgeon is operating on a child during the same session as a plastic surgeon doing a cleft palate repair or a urologist performing a urologic procedure such as a...Converting a service from a laparoscopic to open procedureMarch 2nd, 2009 - Codapedia Editor
Some surgeries are planned to be laparoscopic procedures, but the physician needs to convert the service to an open procedure. In that case, bill only for the open procedure. If there was significant extra work, meeting the criteria for use of modifier 22, and this is documented, then add that to...Multiple endoscopic proceduresFebruary 10th, 2009 - Codapedia Editor
Medicare uses different rules to pay for multiple surgical procedures and multiple endoscopic procedures. For non-endoscopic procedures, the service with the highest RVU is paid at 100% of the fee schedule, and at 50% for the second to the fifth procedure.
Multiple unrelated endoscopic...