Forum - Questions & Answers

Sep 15th, 2016 - LBAROGIANIS 250 

Coding help!!!!!!!!!!!!!!!

Patient came in to ER unresponsive. Patient has a large intraparenchymal hematoma in the right temporal lobe. The doctor did the consult, then ICP monitoring in the ER and then to the OR for craniotomy.
Our coder coded for the diagnosis codes I61.0 and I62.01 for the surgery this: 99223-57, 61210 61312-58

Wellcare denied CPT® 61210 stated included in CPT® 61312.

Can anyone tell me what I am doing wrong? I originally tried with modifier 59 but that didn't work either.

Thank you in advance,

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Sep 15th, 2016 - afgbilling 59 

re: CODING HELP!!!!!!!!!!!!!!!

CCI edit: 61210 is bundled into 61312. You may override the edit with a modifier (58, 59, 78, 79, 91, LT, RT, E1-E4, FA, F1-F9, TA, T1-T9, LC, LD, RC, LM, RI, XE, XP, XS, XU) on 61210 if circumstances and documentation support 61210 being distinct from 61312
Tips
Whenever you encounter the term burr hole while reading the operative report, distinguish between a burr hole the provider performs as a primary surgical approach versus those he makes in conjunction with a craniotomy. In a procedure commonly described as a bone flap craniotomy, a provider drills several burr holes to help develop a bone flap. If this is the case, the surgical approach is not a burr hole, but rather a craniotomy or craniectomy, and you should use the correct craniotomy or craniectomy code.

(This is from my claim scrubber tools)

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Sep 21st, 2016 - LBAROGIANIS 250 

re: CODING HELP!!!!!!!!!!!!!!!

Thank you for your answer. Sorry I am late responding. The patient came in through the ER had the ICP (61210) place on the Left frontal region at the Kocher's point (burr hole). Then the patient got worse later on and the dr did an emergency surgery (61312), on the Right at the superior temple line a burr hole was placed and the bone flap was fractured and held in place. Wouldn't this be considered a Staged Procedure? I feel its at two separate sessions and not the same site for burr holes.

With the given information above, what are your thoughts now?
Thank you!

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