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Umbilical Hernia Repair with another Laparoscopic Procedure
When our surgeon is performing a non-hernia laparoscopic procedure and a port is placed in the umbilicus, can we also code to repair a known asymptomatic umbilical hernia at the same time as the non-hernia laparoscopic procedure?
Question:
When our surgeon is performing a non-hernia laparoscopic procedure and a port is placed in the umbilicus, can we also code to repair a known asymptomatic umbilical hernia at the same time as the non-hernia laparoscopic procedure?
Answer:
No; when a laparoscopic port is placed at the umbilical site, the repair of the umbilical hernia would be considered included and not separately reported.
*This response is based on the best information available as of 620/24.
Breast Biopsies on Both Breasts – Same Session
Our breast surgeon performed biopsies (with a clip) on both the right and left breasts using ultrasound imaging. Do we code 19083 x 2 units since they are different breasts, or would we use 19083 and 19084 as the add-on code?
Question:
Our breast surgeon performed biopsies (with a clip) on both the right and left breasts using ultrasound imaging. Do we code 19083 x 2 units since they are different breasts, or would we use 19083 and 19084 as the add-on code?
Answer:
If additional lesions (as you have described above) are biopsied in the contralateral breast using the same imaging, report the primary code and the add-on code for the second lesion. If more than one lesion is biopsied, using different imaging modalities, report the appropriate primary code for each.
*This response is based on the best information available as of 4/11/24.
Selective Debridement of Multiple Ulcers
Selective debridement was performed on 3 separate ulcers, 3 ulcers of the distal legs; 2 are on the right leg and 1 is on the left leg.
Question:
Selective debridement was performed on 3 separate ulcers, 3 ulcers of the distal legs; 2 are on the right leg and 1 is on the left leg. Depth and size of debridement is documented as
15 sq cm, skin, subcutaneous tissue and muscle, right leg
10 sq cm, skin, subcutaneous tissue and muscle, left leg
10 sq cm, skin, subcutaneous tissue, muscle, and bone
How is this reported?
Answer:
Selective debridement of ulcer of the same depth are added together, regardless of their location. So, in the above scenario, the debridement of subcutaneous tissue and muscle are summed, for a total of 25 square centimeters. This is reported as codes, 11043 Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or and +11046 each additional 20 square cm or part thereof.
The additional 10 square centimeter to a depth to bone are reported with code 11044, Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less.
*This response is based on the best information available as of 3/14/24.
Denials for Initial Hospital Care and Observation E/M Codes: 2024
We are experiencing denials when we bill 99221-99223 and the place of service is observation (outpatient hospital). Are we doing something wrong?
Question:
We are experiencing denials when we bill 99221-99223 and the place of service is observation (outpatient hospital). Are we doing something wrong?
Answer:
You are billing correctly based on CPT 2023 guidelines for E/M that merged inpatient hospital encounters/codes with observation encounters/codes. Unfortunately, some payor claims processing systems may not yet recognize these changes as they apply to billing. You will have to appeal these denied claims, with CPT references showing the current guidelines for E/M reporting.
*This response is based on the best information available as of 2/29/24.
Coding Laparoscopic Liver Biopsy
Question:
How is a laparoscopic biopsy of the liver reported. Can we use code 47001, Biopsy of liver?
Answer:
47001 Biopsy of liver, needle; when done for indicated purpose at time of other major procedure (List separately in addition to code for primary procedure) may only be reported with an open procedure. See CPT Assistant 1992 below. If a laparoscopic biopsy of the liver is performed at the same time as another laparoscopic procedure, for example a laparoscopic cholecystectomy, report an unlisted code (47379). There is no CPT code for a laparoscopic liver biopsy.
*This response is based on the best information available as of 2/1/24.
Cholecystotomy Procedure
How should you code an open cholecystotomy, with a drain placement and a biopsy of the gallbladder wall is performed. Can the biopsy of the gallbladder be separately reported?
Question:
How should you code an open cholecystotomy, with a drain placement and a biopsy of the gallbladder wall is performed. Can the biopsy of the gallbladder be separately reported?
Answer:
No, the biopsy of the gallbladder wall is not separately reportable this is bundled and inclusive to the cholectstotomy. The correct code to report for this procedure would be CPT 47480,Cholecystotomy or cholecystostomy, open, with exploration, drainage, or removal of calculus (separate procedure).
*This response is based on the best information available as of 12/14/23.
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