Pediatric Coding Alert

READER QUESTIONS:

Employer, Not You, Determines Surgery Co-Pays

Question: We are having an issue in our pediatric office regarding 56441. The patient had a vaginal adhesion which was corrected simply in the doctor's office. The problem is that the patient is getting charged a higher copay because of the surgical coding used. I have looked in the CPT book and asked many certified coders how this should be coded since an actual "surgery" was not performed. They are all stumped. Do you have any suggestions? Ohio Subscriber Answer: Your coding seems appropriate. For removal of labial adhesions, which is performed using a blunt instrument or scissors under general or local anesthesia, you should report 56441 (Lysis of labial adhesions). In a non-facility setting, the code has 3.94 relative value units (RVUs), according to the 2009 Medicare Physician Fee Schedule, which you can use to judge private payers' rates. The procedure includes a 10-day global period, which a payer [...]
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