Go Back   AAPC Medical Coding & Billing Forums > Medical Coding > Cardiovascular Thoracic
Forum Rules FAQ Members List Calendar Search Today's Posts Mark Forums Read

Reply
 
Thread Tools
  #1  
Old 12-17-2008, 10:27 AM
dpumford dpumford is offline
Expert
 
Join Date: Apr 2007
Posts: 271
dpumford is on a distinguished road
Default Mediastinal exploration

HI!

We had a patient that had a AVR done. Pt was taken off bypass and chest was closed and sternum wired.. Then because of the chest tube output that was present the doctor determined that he needed to re-explore the chest.

Patient was re-steriley prepped and drapped. The skin incision was re-opened and wires pulled and removed. After exploration which the source of bleeding could not be found chest was re-closed and re-wired.

Since the patient never left the OR room 35820-78 is not appropriate?? I was leaning toward procedure 20680.

Any advise would be Greatly appreciated.
Thank you!!
Reply With Quote
  #2  
Old 12-18-2008, 11:24 AM
MLS2 MLS2 is offline
Expert
 
Join Date: Apr 2007
Posts: 276
MLS2 is on a distinguished road
Default

I'm not sure, but I think I would do the 35820. The re-exploration was done after the chest was closed and pt. was weaned from bypass. I'm not sure that you would need the 78 mod. though since it wasn't a "return" to the OR.
Reply With Quote
  #3  
Old 12-19-2008, 10:37 PM
jdrueppel jdrueppel is offline
Expert
 
Join Date: Apr 2007
Location: Lincoln, NE
Posts: 435
jdrueppel is on a distinguished road
Default

OK -this is not my specialty so I'm just throwing this out there for discussion.

http://www.cms.hhs.gov/NationalCorre....asp#TopOfPage

Above is the NCCI Website address. If you go to NCCI Policy Manual for Medicare Services and select Chapter 5 for services within CPT codes 30000-39999. Towards the end it states that 20670/20680 is not separately billable. It goes on to state that 35820 is not separately billable unless it is a "return to surgery". So then, I'm down to the -22 modifier for unusual service but is it truly unusual when these services are inclusive per the above guidelines BUT I could justify with increased time and intensity due to chest closure x2....... I know you guys deal with real world coding and I may be way off but thought I'd share the information for discussion.

Julie, CPC

Last edited by jdrueppel; 12-22-2008 at 02:00 AM.
Reply With Quote
  #4  
Old 01-07-2009, 01:21 AM
lisammy lisammy is offline
Guru
 
Join Date: Apr 2007
Posts: 153
lisammy is on a distinguished road
Default

Since the valve procedure was complete and the incision was closed, may I suggest 35820 with a 59 modifier, it was a seperate and distinct procedure, make sure to use a 998.11 as the diagnoisis.
Reply With Quote
  #5  
Old 01-07-2009, 07:33 PM
MLS2 MLS2 is offline
Expert
 
Join Date: Apr 2007
Posts: 276
MLS2 is on a distinguished road
Default

I was thinking to use the 35820 as well but I asked the CT surgeon that I bill for and he thinks that it should be included in the original procedure...maybe a 22 modifier, but he doesn't think a separate billing should occur. So I'm kind of on the fence on this one.
Reply With Quote
  #6  
Old 01-26-2009, 06:00 AM
krmichae krmichae is offline
Contributor
 
Join Date: Apr 2007
Posts: 14
krmichae is on a distinguished road
Default

I agree with the surgeon. The patient never left the OR so the 35820 is not applicable. This would be considered content of service in our practice.
__________________


Kristi Michaelson, CPC
Coding & Compliance Coordinator
Cardiothoracic Vascular Surgeons
Reply With Quote
  #7  
Old 02-06-2009, 03:20 PM
cgorder cgorder is offline
New
 
Join Date: Apr 2007
Posts: 5
cgorder is on a distinguished road
Default

I have had similiar situations like this and have inquired to the STS. The advise was because this was during the same encounter and he never left the OR, I should bill with 22. Had he left the OR then you could use the 35820-78.
__________________
C.Hilliard
Reply With Quote
Reply

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off




Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.

All times are GMT -6. The time now is 09:49 PM.

AAPC - Top

Powered by vBulletin® Version 3.8.1
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.
Copyright ©2014, AAPC