Code +15777 for Placement of a Non-biologic Implant. Is this the Correct Code?

Question:

I placed a non-biological implant for abdominal soft tissue reinforcement. Can this be coded as +15777?

Answer:

No. Code +15777 is reported specifically for abiological implantfor soft tissue reinforcement implant in breast or trunk only. Code +0437T, a Category III code, is reported for implantation of anonbiologic or synthetic implant(eg, polypropylene) for fascial reinforcement of the abdominal wall. A Category III code is intended as a temporary or tracking code, and payment is carrier determined. Payors may consider Category III codes to be investigational and therefore not covered. To increase chance of payment, have always have the procedure pre-authorized.

*This response is based on the best information available as of 05/11/23.

Reporting a Cholecystectomy and an Umbilical Hernia at the Same Operative Session

Question:

If a patient undergoes an open cholecystectomy and has a reducible umbilical hernia repaired during the same operative session, through separate incisions, can both be reported?

Answer:

Yes, if both procedures were performed through separate incisions both may be reported. Conversely, if both were repaired through the same incision, only the cholecystectomy would be reported.

*This response is based on the best information available as of 04/27/23.

Reporting a Cholecystectomy with a Cholangiogram

Question:

If a cholangiogram was performed by the surgeon during a cholecystectomy, but the radiologist interprets it, is 47563,Laparoscopy, surgical; cholecystectomy with cholangiographystill appropriate?

Answer:

Yes, the codes “with cholangiogram” are valued for intraoperative physician work, not the interpretation.

*This response is based on the best information available as of 04/13/23.

Billing for an Iatrogenic Injury, Not my Patient (Stage 2)

Question:

My surgeon was called to the OR by an OB-GYN who accidently lacerated the bowel during an open gynecological procedure. She repaired the bowel with sutures. Should the diagnosis code be the same diagnosis as the reason for the primary surgery?

Answer:

No. The diagnosis code for your surgeon would beK91.71 Accidental puncture and laceration of a digestive system organ or structure during other procedure.

*This response is based on the best information available as of 03/30/23.

Billing for an Iatrogenic Injury, Not my Patient (Stage 1)

Question:

My surgeon was called to the OR by an OB-GYN who accidently lacerated the small bowel during an open gynecological procedure. She repaired the small bowel with sutures. How is this billed, is my surgeon a co or assistant surgeon?

Answer:

Neither. Repairing the bowel is not inherent to a gynecological procedure so your surgeon would not be a co or assistant surgeon. Instead she will bill for the work she performed, code 44602,Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture; single perforation.

*This response is based on the best information available as of 03/16/23.

Billing for an Iatrogenic Injury, My Patient

Question:

The surgeon reported an intestinal perforation caused by a trocar during a laparoscopic cholecystectomy due to extensive adhesions. He completed the cholecystectomy and also did a suture repair of one perforation of the small intestine. How is this reported?

Answer:

Iatrogenic, intraoperative complications that are repaired at the same operative session are not separately reported. Since the small bowel perforation was an iatrogenic injury, inadvertently done by the surgeon during a surgery, it is not reported. Only the cholecystectomy should be reported.

*This response is based on the best information available as of 03/02/23.