General Surgery Coding Alert

Recall X{EPSU} options.

Modifiers can make or break your Medicare claims, so take this opportunity to refresh your expertise by trying your hand at coding the following cases. Then turn to the answers below to see how you did compared to our experts.

Question 1: A patient comes to the office a few days after an appendectomy complaining of severe reflux. The doctor talks to the patient about the symptoms and performs a physical exam, taking about 15 minutes. You should report the appropriate office visit code, such as 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity ...). What modifier should you append?

Question 2: A patient presents to the emergency department (ED) with nausea and severe lower-right abdominal pain. The surgeon examines the patient and orders labs and radiology services to rule out appendicitis. Based on the test results, the surgeon makes the decision for surgery, performs an open appendectomy, and admits the patient to the hospital. What is the best modifier for this scenario?

Question 3: Your surgeon performed a lumpectomy on a patient’s left breast for a patient with a prior diagnosis of DCIS. At the same session, the surgeon performed a breast biopsy with ultrasound guidance on the patient’s right breast for a different lesion. Do we need a modifier to code both these procedures, and if so, which one?

Question 4: During a laparoscopic partial colectomy with anastomosis, the surgeon encountered extensive adhesions and spent significantly more time performing complex cutdown in the surgical field. The op report also shows a diagnosis of K66.0 (Peritoneal adhesions (postprocedural) (postinfection)). What modifier might help in this scenario?

Question 5: A surgeon sees a patient for a complaint of an umbilical hernia. While there, the patient asks about a large blackhead on her back. The surgeon determines that the back lesion is a sebaceous cyst, and decides to excise the cyst today instead of requesting that the patient return. The surgeon excises a 1.8 cm cyst. What modifier should you use?