Re-excision of lesions
Q. How would you code for shaved excision of skin lesion on the right thigh? The biopsy came back stating the lesion appears incompletely excised.
A. Report the initial procedure using a code from the series 11300-11303 (shaving of lesion, trunk, arms, or legs). The exact code selection is based on the diameter of the lesion. Code the re-excision using a code from the excision series, either benign (11400-11406) or malignant (11600-11606). You need to know the excised diameter -- the lesion plus margins -- in order to pick the appropriate code. You might want to wait for the path report before coding, since the payment is greater should it be a malignant lesion. You do not need a modifier on the second procedure since the 11300 series of codes have 0 global days.
Q. The doctor performed a video laparoscopy, left salpingo-oophorectomy, right ovarian cystectomy, and peritoneal biopsy. What CPT codes and modifiers would you use?
A. The correct codes are 58661 and 49321-51. Code 58661 describes partial or total oophorectomy and/or salpingectomy. If you look up ovarian cystectomy in the index of CPT, you are referred to code 58661 for that portion of the procedure also. The code cannot be reported with the bilateral modifier, which means that although procedures were done on the right and left sides, this code includes both procedures.
Report 49321 -- laparoscopy, surgical; with biopsy -- for the peritoneal biopsy and, since it is the lesser service, add the
-51 modifier. These codes are not bundled under CCI, therefore, the -51 modifier is used instead of the -59.
Q. How do you bill for FOBT screenings? If there are three screenings on three different days, do you bill for three tests using a date range or bill the date the tests were brought into the office and bill one charge?
A. CPT code 82270 for FOBT is for one to three determinations. It should be reported only once for up to three readings.
To bill Medicare, use G0107. This code describes at least two determinations from three separate sites. It is only reported once and most definitely should be reported only when the patient returns the cards and the interpretation is provided. The date of service in both instances is the date the interpretation is done.
Defibrillation during procedure
Q. Is there a legitimate way to capture the charge for a nonelective cardioversion? For example, if a patient needs defibrillation during another procedure, such as a heart catheterization, can we bill for it?
A. Defibrillation during cardiac cath is not separately reportable. If critical care services are provided, then it would be appropriate to report the critical care codes (99291-99292), which include cardioversion.
Q. My physician performed an anal sphincter dilation in the office. Should he bill 45905 (dilation of anal sphincter [separate procedure] under anesthesia other than local) with a -52 modifier because it was done without anesthesia?
A. If this was the only procedure provided, then it would be appropriate to report the code 45905 with the -52 (reduced services) modifier. If it was performed in conjunction with another service, be sure it is not a component of the other procedure. 45905 is a "separate procedure" code which means it is generally a part of another service performed at the same encounter.
Modifiers -59 and -22
Q. Can you give me a clear explanation of the -22 and -59 modifiers?
A. Modifier -22 is appended when a procedure required significant work beyond the usual care associated with the code. Payers require documentation that describes the additional work in terms of complexity of the case and the additional physician work or time required to perform the procedure. The exact nature of the work varies according to the circumstances of the individual case.
The -59 modifier is appended to CPT codes performed in conjunction with another procedure when the procedure is generally a required or incidental component of the other. Codes that have a "separate procedure" designation in CPT are generally included in the payment and descriptor of another more comprehensive procedure performed at the same setting.
The -59 is applied to the "separate procedure" codes when it is in some fashion distinct and independent of the other procedure being performed. This might be surgeries performed in different compartments of the knee, for example.
The -59 is also used when the codes are bundled under Medicare's CCI (bundling rules). The CCI lists code pairs that are generally not reported together, but in which it may be appropriate under certain conditions (distinct services). This may be, for example, a different anatomic site or setting.
The use of the modifier depends on the exact code pair being submitted. It is only used if the services are distinct from each other. Services that are integral to the performance of another procedure are not reported separately and the -59 modifier should not be applied in these situations.
Scalp lesion removal
Q. I have a question regarding coding of an excision of a scalp cyst. In the CPT book, there is not a code under excision, head. Do I just code this under skin excision?
A. You use a code in the 1142x series of codes. These describe removal of benign lesions from the scalp. The introduction to the removal of lesion codes lists cystic lesions as an example of conditions for which these codes are appropriately reported.
Q. What CPT code do you use for open laparoscopy? The patient has endometriosis.
A. Use the applicable laparoscopy codes in the 58660-58673 series of code. If appropriate, the -22 modifier can be appended.