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Number and Complexity of Problems Addressed
I see a lot of patients with chronic pain and other issues. What defines “stable” vs. “exacerbation or progression”?
Soft Tissue Tumors
I just started coding for Dermatology practice. I need some clarity on soft tissue tumor excisions. My physicians are telling me that when a soft tissue tumor excision is performed, the procedure includes all repairs, including a flap repair. If the physician removes a soft tissue tumor and does a flap on the same day, can I report the flap separately?
Risk of Patient Management
I am a Pain Management Physician. I have a patient with lumbar spinal stenosis who has completed two months of physical therapy and 2 epidural steroid injections, but significant pain still persists. Given extensive conservative management has failed to provide adequate relief I am now recommending a surgical consultation with a spine physician. I document, “We discussed risks of surgery including bleeding, infection, nerve damage as well as patient-specific risks including hypertension. After discussing the risks and benefits of surgery, the patient elects to continue conservative management”. Does this count as a decision for surgery (moderate risk)? I am not clear on if I can make a “decision for surgery” as a non-surgical physician.
ENT Modifier 24
My physician saw a patient three weeks post op after an adenoidectomy. The patient is complaining of ear pain at this visit. Can I report am E/M service with Modifier 24?
Lower Extremity Intravascular Lithotripsy
How do we code for lower extremity Intravascular Lithotripsy (IVL)? Can physicians use HCPCS codes C9764-C9767?
Laminoplasty Scenarios
In our spine practice we often see different laminoplasty scenarios for coding. Is it ever appropriate to report decompression in addition to laminoplasty (63051)? Hope you don’t mind, but I have included a couple of commonly seen laminoplasty scenarios from our practice that we are eager for KZA’s opinion.
Scenario #1 Our surgeons wish to bill 63051 for laminoplasty (C4-C6) and 63020 & 63035 for foraminotomies (C4/5 & C5/6) because they say it's a significant amount of work. We struggle with this one, is this appropriate?
Scenario #2 Laminoplasty performed from C4-C6, and decompression performed at C2/3?
Scenario #3 Laminoplasty performed from C4-C6 with partial laminectomies performed at C3 & C7.
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