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nielynco's latest activity
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nielynco reacted to csperoni's post in the thread Wiki Coding for a total vaginal hysterectomy with laparoscopic removal of tubes/ovaries with
Like.
Coding separately for the hysterectomy and salpingo-oophorectomy is unbundling. You do not code separately for each of the components when there is a single code that represents all of the work. While the original plan may have been for total... -
nielynco reacted to Pam Warren's post in the thread Wiki billing for a consult during surgery? with Like.
If you're the coder for the OBGYN, and he/she wrote a consultation note, and there is a request for the consultation in the surgeon's note, you can bill an E&M/consultation for the OBGYN. Otherwise, you wouldn't bill anything.
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nielynco replied to the thread Wiki Coding for a total vaginal hysterectomy with laparoscopic removal of tubes/ovaries.This surgery represents a laparoscopically assisted vaginal hysterectomy and you would code either 58552 or 58554 depending on the weight of the uterus which might just be more than 250g given the additional work required.
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ACOG has a LARC coding guideline, but to reiterate what was said above, a provider should not be standardly charging an E+M in this situation. Here is a snip from a PDF version
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nielynco replied to the thread Wiki myomectomy 58140 vs 58146 when only 3 myomas but weighs 540 grams total. which code do we choose?.The weight only applies to intramural fibroids (ones that are imbedded in the uterine wall), not surface myomas or a combination thereof. So if all of myomas were intramural with a weight over 250 g you go with 58146. If they are all surface...
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nielynco replied to the thread Wiki Counseling patient on options for pregnancy.Yes, the US has confirmed pregnancy.
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This handout goes over all the pessary coding scenarios very nicely. https://www.augs.org/assets/1/6/2018_CodingFactSheetforPessaries.pdf
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nielynco replied to the thread Excision of fibroid of vulva.Vulvar leiomyomas are very rare and are frequently initially identified as a Bartholin's glad cyst which was the case here. However, 56630 represents a radical vulvectomy, which was not performed (a partial radical vulvectomy includes partial or...
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nielynco replied to the thread Wiki OB ULTRASOUND.No. You are not performing a repeat procedure on the same fetus. Per a CPT Q&A: For reporting multiple gestation fetal biophysical profiles, code 76818 or 76819 should be reported once for each fetus. Fetal biophysical profile assessments for...
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nielynco reacted to csperoni's post in the thread Wiki Assistance with Hysterectomy Codes with Like.
It's rare my clinicians perform LAVH vs TLH. However, my trick if unsure is to look when the colpotomy was performed. The surgeon wasn't doing any portion vaginally until they opened the vagina. If all the ligaments and arteries were severed...
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I agree with @Cmama12. I would bill 57160 for the day of the actual fitting. Generally, for practices that treat a lot of prolapse, they keep various types/sizes of pessaries in stock so the fitting and the insertion are the same day. If that...
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nielynco replied to the thread Wiki OB code sequencing - we're having a debate.The ICD10 guidelines do not address this issue directly, but in multiple examples they have provided via their Q&A they indicate that as long as the primary/first listed Dx is from Chapter 15, the other diagnoses used would follow whatever rule...
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nielynco replied to the thread Wiki Assistance with Hysterectomy Codes.You are correct. This qualifies as a total laparoscopic hysterectomy rather than a LAVH because they severed all attachments via the scope. The uterus can be removed vaginally or via the scope and this would still be coded as 58571.
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Hi, unless I missed something, it appears all the uterine attachments were severed via the scope, and the specimen was removed vaginally. I would code 58571. For an LAVH, you would see the uterosacral/cardinal ligaments severed via a vaginal...
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Usually that is all done at the same session, and 57160 includes fitting and placement. For my two cents, I would bill 57160 for the fitting, and wouldn't bill additionally for the insert. Clinical Responsibility The provider performs a...