Use of Tissue Adhesive for Laceration Repair

Question:

Does use of a tissue adhesive “count” as a layer for the laceration repair codes?

Answer:

Actually, yes it does! The CPT guidelines state “Use the codes in this section to designate wound closure utilizing sutures, staples, or tissue adhesives (e.g., 2-cyanoacrylate), either singly or in combination with each other, or in combination with adhesive strips. Wound closure utilizing adhesive strips as the sole repair material should be coded using the appropriate E/M code.” This means sutures, staples or a tissue adhesive “counts” as a wound closure technique for 12001–13160. However, steri-strips do not.

*This response is based on the best information available as of 07/21/16.

Coding Lymph Node Excision, Biopsy and Lymphadenectomy

Question:

During a lumpectomy, if the results of an axillary lymph node excision and biopsy (38525) lead to an axillary lymphadenectomy (38745), are both codes reported in addition to 19301, the lumpectomy?

Answer:

No, a lumpectomy with a deep axillary lymphadenectomy is reported with a single code, 19302, Mastectomy, partial (e.g., lumpectomy, tylectomy, quadranectomy, segmentectomy); with axillary lymphadenectomy. This code is valued for the lumpectomy and the axillary lymphadenectomy. The excision of lymph nodes for biopsy, 38525, is not separately reported as it is included in the total lymphandectomy.

*This response is based on the best information available as of 06/23/16.

Three Layer Closure = Complex Repair?

Question:

Is a 3-layer closure after a malignant skin lesion removal considered a complex repair code (131xx)?

Answer:

No. Actually, CPT says a “Complex repair includes the repair of wounds requiringmore than layered closure, viz., scar revision, debridement (e.g., traumatic lacerations or avulsions), extensive undermining, stents or retention sutures.” The emphasis (bold) is added to show that a complex repair code requires more than a layered closure. The intermediate repair (12xxx) code guidelines say a “layered closure of oneor moreof the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition to the skin (epidermal and dermal) closure” is performed. The emphasis (bold) is added to show that one or more (e.g., two, three) layers repaired is considered an intermediate repair after excision of a skin lesion.

*This response is based on the best information available as of 05/26/16.

Minor vs. Major Procedure

Question:

What is the difference between a minor and major procedure?

Answer:

A minor procedure is defined as one with a zero or 10 day global period.  For example, debridement has a zero day global period, and excision of a benign skin lesion has a 10 day global period.  A major procedure is defined as one with a 90 day global period.  Most open surgical procedures have a 90 day global period. Procedures are paid a global “flat fee” and E/M visits and other procedures directly related to the original procedure during the global period are considered inclusive to that procedure and not separately reported/billed.  Exceptions occur and modifiers are used to describe these exceptions and allow payment. For example, you perform an unrelated procedure during the global period or one that is staged from the first.  Refer to the modifier section of the CPT manual for descriptions of modifiers and attend a KZA Coding workshop to learn how to accurately use modifiers specific to your specialty.

*This response is based on the best information available as of 05/12/16.

Tympanostomy Tube with Intratympanic Injection

Question:

I did an intratympanic steroid injection and coded 69801 and 69433. Medicare paid 69801. Should I appeal the denial of 69433?

Answer:

No! CPT 69801 says Labyrinthotomy, with perfusion of vestibuloactive drug(s); transcanal. The CPT guidelines say: Do not report 69801 in conjunction with 69420, 69421, 69433, 69436 when performed on the same ear. By billing 69801 and 69433, for procedures on the same ear, you’ve unbundled the codes. The denial is accurate so you should not appeal. Furthermore, in the future, do not bill 69433 or 69436 (tympanostomy tube placement) or 69420 or 69421 (myringotomy) for the same ear when you also report 69801.

*This response is based on the best information available as of 04/28/16.

Excision of “Dog Ear” at Time of Breast Reconstruction

Question:

What code should I use for excision of a “dog ear” of the reconstruction flap that was done at the same time as the second stage of breast reconstruction?

Answer:

Actually, excision of the dog ears is included in the primary procedure code for your second stage procedure and should not be separately reported with a lesion removal code (e.g. 114XX) or any other code.

*This response is based on the best information available as of 03/17/16.