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    Wiki Co-surgeon questions

    I think I have a two fold question. I was under the impression true co-surgery was only performed when two surgeons of different specialty's perform components of the same surgical code. Our providers will occasionally assist each other on more difficult cases, all our providers are of the same...
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    Wiki Nerve transection due to scar tissue

    Hello, I want to make sure I am clear on how to bill/not bill for accidental lacerations during a procedure. I understand the CMS NCCI manual has instructions on iatrogenic incidents in certain chapters relating to specific procedures, but there isn't any guidance in the musculoskeletal...
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    Question Intermediate Repair Face/Scalp

    Hello, What documentation is everyone looking for to support intermediate repair on the face/scalp? I recently had a discussion with one of my surgeons and they were questioning the subq repair in the face/scalp given some areas have little/no subq. They often do wide undermining in these areas...
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    Wiki 26121 and 26123

    Hello, I understand the difference between 26121 and 26123. I am questioning if my provider performs a partial palmar fasciectomy including pip joint (26123) on the pinky and then in a totally separate incision did fasciectomy of the palm only at the base of the index finger (26121), could we...
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    Wiki Therapeutic Activities and Lcodes

    Hello, We have been issued a denial siting Medicare Guidelines, for L3999 when billed with 97530. We supplied the MAC with appropriate information to support unlisted code and were issued a denial stating bundled to 97530 per Medicare policy. I can't find a Medicare policy that indicates...
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    Wiki Mallet Finger 26432

    Hello, Recently, our practice has been discussing use of 26432. The lay description from OPTUM states "The physician repairs the distal insertion extensor tendon without incising the skin. The physician uses a splint to pin the finger in an extended position. If extensive damage occurred during...
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    Wiki Lateral Canthus Skin Cancer

    Hello, I am curious what people are using for diagnosis for lateral canthus skin cancers? For example, I have a patient who has has BCC of the lateral canthus of the left eye, its not specific to the upper or lower eyelid, its right in the center. What would you select as a diagnosis code? I am...
    • apoland
    • Thread
    • eyelid skin cancer icd 10
    • Replies: 1
    • Forum: ICD-10
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    Wiki Non-manipulative fracture care

    Hi, Can someone help me rationalize non-manipulative fracture care. For example, I have a patient who had a finger fracture, that did not require surgery, only splinting. The provider replaced the splint they already had with a new one and sent them to be scheduled with OT for splint creation...
    • apoland
    • Thread
    • finger fracture nonmanipulative fracture care
    • Replies: 0
    • Forum: Orthopaedics
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    Wiki AIN to Ulnar nerve transfer

    My surgeons are starting to perform AIN to Ulnar nerve transfer more often and we are trying to determine the most appropriate coding. 64905 states a first stage nerve transfer, however we are not doing staged work, we are doing a permanent transfer. 64718 includes transposition but does it...
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    Wiki Multiple Deep Sutures in Tendon Removal

    I have a physician who removed 3 deep tendon sutures and wants to bill x3 20525. I feel because there is 1 incision we should only be billing 1 unit. Can someone help confirm with me what the appropriate units should be? Thank you!
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    Wiki Skin Grafting and Closure

    Hi everyone, I have a malignancy excision 6.5 x 4 cm; 1.5cm of the defect was closed with a layered closure the remaining 5 x 3 cm was grafted closed with a FTSG. The surgeon wants to code for the layered closure, however, I question if this is bundled to the graft? Thanks Autumn
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    Wiki 21310

    Hi, I need clarification on billing this code. I understand global fracture care billing, however this code throws me off. It does not involve splinting or manipulation so what exactly is it billing? I don't see how we can bill an office visit and also this code if the physician only looked at...
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    Wiki Closed finger joint capsulotomy

    Hi, I have two physicians who each performed a closed capsulotomy of a finger joint by "forcibly flexing joints all the way to 90. With some time and sustained flexion, we were able to get full flexion. There was audible and palpable crunching of scar tissue snapping during this maneuver." They...
    • apoland
    • Thread
    • closed capsulotomy finger joint manipulation finger
    • Replies: 3
    • Forum: Orthopaedics
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    Wiki Occipital bone cyst removal by burring

    Hi, Need clarification on CPT coding for "Burring down of right postauricular exotosis of the skull." We see 21029 "Removal by contouring of benign tumor of facial bone" however this was the temporal bone, and isn't technically classified as facial bone. The other code we found was 61500...
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    Wiki 76000 vs 77002

    I work in a plastic/reconstructive surgeons office and we do a lot of hand/wrist work including injections. Something I am seeing a lot of is the use of 77002 and 76000. My understanding of the descriptions of each is that 76000 is to be used for more extensive imagining i.e. confirmation of...
    • apoland
    • Thread
    • 76000 77002 fluoroscopy fracture injection
    • Replies: 2
    • Forum: Orthopaedics
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    Wiki 26356 Tendon repair and casting

    Hi, My doc did a tendon repair 26356 and applied splinting 29125 the same day. I know that there is a note that splinting, unless replacement, is not allowed same day as restorative treatment, however when checking CCI 26356 and 29125 (splinting) can be billed together. Does the rule on...
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    Wiki AARP MEDICARE COMPLETE OT Evaluations

    Hi, I have a patient who was seen in OT for therapies relating to CTS. AARP MEIDCARE COMPLETE denied stating not medically necessary. They original claim did not have quality codes present, but I have since rebilled and received the same response. Anyone seen this happen? The MEDICARE LCD...
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    Wiki 1 year follow up visit after breast reconstruction

    I have a patient who is being seen for their 1 year post reconstruction for breast cancer follow up. Z08 and Z85.3 post say they are not acceptible primary diagnoses. What should I be using?? Patient has no issues. "On examination she’s alert and cooperative in no acute distress. She’s very...
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    Wiki Nerve coding resources

    We have a new provider in our surgery practice who is bringing in a lot of nerve related procedures. Are there resources out there that anyone can suggest? Thanks
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    Wiki Codebusters

    Has anyone heard of the company Codebusters? They seem a little too good to be true and I was curious if anyone has experience with them. Thanks!
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    Wiki Breast Reconstruction with serratus fascia flap

    I have a physician who has been using a serratus fascia flap in lieu of alloderm on certain patients. He wants to bill 19357- for the insertion of the tissue expander and 15734- serratus flap. Now I know that there is a conflict with theses two codes without a modifier. I thought 19357 included...
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    Wiki Sensory nerve repair

    I am not well versed in nerve repair coding could I get some help on the following situation: " I then used meticulous dissection technique to isolate the dorsal sensory branch of the radial nerve as it was emanating from the arm next to the brachioradialis. I then proceeded to identify the...
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    Wiki Avulsion INj ICD 10

    Hi, Dr. dictates that patient experienced an avulsion injury of skin/tissue down to tendon of left small finger. No tendon injury etc. It was pulled off by a sweatshirt string. How do you code this? Its not a bite or puncture? I don't really see it as a laceration either. Thanks!
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    Wiki Open Wound Coding

    Pt has an "open wound" of finger due to raynaud's disease. The only open wound codes are unspecified, laceration and puncture wound. We don't believe it really fits under either. How would we code this with ICD 10? Would we use a non-pressure ulcer code or an unspecified, laceration or puncture...
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    Wiki D05 vs. C50 for breast cancer

    Hi, I am looking for clarification between the codes in category D05 and C50. I see a lot of invasive ductal carcinoma and ductal carcinoma in situ. Would we use the D05 codes for the ductal carcinmoa in situ and the C50 for any invasive ductal carcinomas or breast cancers not specified as...
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