Post-Op Anterior Cervical Wound Abscess

Question:

How do I code for repair of wound dehiscence with deep abscess status post ACDF (anterior cervical discectomy, decompression and fusion)? I looked at 22010 but that’s for a posterior procedure.

Answer:

Take a look at 21501 (Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax) to see if it meets your needs.

*This response is based on the best information available as of 10/1/20.

Modifier 78: Global Period Impact

Question:

We have a patient who had knee surgery and required a return to the operating suite for treatment of a complication during the global period. We will bill the second surgery with a modifier 78. My supervisor is saying the aftercare needs to be extended another 90 days because the surgeon had to return the patient to the operating suite for the same anatomic site.

I have always understood that modifier 78 does not restart the global period, but now am Question:ing myself. Will you please provide guidance?

Answer:

Thanks for contacting KZA with your inquiry.  You are correct!  Modifier 78 (Unplanned Return To The Operating/Procedure Room By The Same Physician Or Other Qualified Health Care Professional Following Initial Procedure For A Related Procedure During The Postoperative Period) does not restart the global period, and will be subject to a  reduction in reimbursement for the portion of the global period which overlaps with the original surgery.

CMS’s reimbursement formula for a procedure with a modifier 78 does not include payment for post-operative days, thus the global days stay with the original procedure.

I am including an excerpt from a source citation from Novitas (an example Medicare MAC) on this topic; the concept applies to all Medicare claims:

Facts

• An operating room (OR) is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient’s condition was so critical there would be insufficient time for transportation to the OR).
• Modifier 78 allows for the intraoperative percentage only of major or minor procedures (010 or 090 global periods).
• A new postoperative period does not begin when using modifier 78.
• Medicare allows codes with global surgery indicators of XXX and ZZZ in the Medicare Physician Fee Schedule Database separately without modifier 78.

Source:https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00144546accessed 12/23/20

*This response is based on the best information available as of 10/01/20.

Abdominal Fat Pad Core Biopsy

Question:

We did an abdominal fat pad biopsy for primary cutaneous Amyloidosis. Would 49180 or 11104 be the appropriate code for this?

Answer:

49180 is for a core sample within or behind the abdominal cavity. If the core biopsy is documented down to the subcutaneous fat pad only, this is coded as a punch biopsy 11104. And if the provider documents ultrasound guidance with proper documentation (i.e., noting anatomical findings and needle placement), 76942 can be billed as well with modifier 26 if indicated.

*This response is based on the best information available as of 9/17/20.

Actinic Keratoses

Question:

When using liquid nitrogen to for irritated actinic keratoses what CPT codes should I use? I have been using 17110 and my coder told me that was wrong.

Answer:

You should report 17000 for the first AK (Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion) and 17003 foreachlesion treated from 2-14. If you remove 15 or more lesions report 17004 (15 or more lesions). Make certain you document the location of each lesion, method of removal and numbers treated.

*This response is based on the best information available as of 9/3/20.

Coding a Hand Assisted Laparoscopy

Question:

The surgeon described the procedure as a ‘hand assisted laparoscopy”  He brought part of the bowel outside of the body for evaluation.  Does this convert the procedure to open?

Answer:

Mobilizing the bowel outside the body (extracorporeally) during a laparoscopic procedure does not convert the procedure to open,  it is still consider a laparoscopic procedure and coded as laparoscopic.

*This response is based on the best information available as of 9/3/20.

Tissue Expander Exchange with Breast Reconstruction Revision

Question:

At the time of the second stage tissue expander exchange, my plastic surgeon wants to bill 19380 for either liposuction, removing excess scar tissue, removing redundant excess skin or removing adipose tissue. “The lateral aspect of the mastectomy scar is excised along with redundant skin and subcutaneous tissue to revise the reconstructed right breast.” Can 11970 and 19380 be billed together?

Answer:

CPT states that 19380 may be reported for breast revision after reconstruction has taken place. At the time of a 2nd stage, expander to implant procedure, the reconstruction is just now being finalized. Therefore, 19380 would not be reported with 11970 for the same breast. If the expander to implant procedure is more extensive, due to the reasons you list, then you could potentially report 19342 instead of 11970.

*This response is based on the best information available as of 09/03/20.