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Issue #4 - December 5, 2012

Coding/Billing Tips and Resources


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Know When to Report Excision or Repair (or Both)

Your surgeon has excised three skin lesions from the patient's left shoulder, and now must close the wounds. Should you report both the excisions and repairs? If so, which is primary?

CPT® guidelines instruct that all benign (11400-11471) or malignant (11600-11646) skin lesion codes include simple wound closure, but you may separately report intermediate (12031-12057) and complex (13100-13153) repairs. Medicare and payers who follow National Correct Coding Initiative (NCCI) edits are more restrictive, and will bundle intermediate and complex repairs for excisions of benign lesions of 0.5 cm or less (11400, 11420 and 11440). You may separately report intermediate and complex repairs for malignant lesions of any size.


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Document Transfer of Care to Get Paid for Post-op Work

Trick question: How many days long is the Medicare 90-day global period? The surprising answer is 92.

"Count 1 day before the day of the surgery, the day of surgery, and the 90 days immediately following the day of surgery," advises the Medicare Learning Network "Global Surgery Fact Sheet."

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EHR Documentation Must Meet the Same Standards as Paper
By Ronda Tews, CPC, CHC, CCS-P

Inadequate documentation is not new to coders, but as offices transition from paper to electronic health records (EHR) coders have a new opportunity to educate physicians when they say, "Oh, that's documented, it's just in a previous visit."

The EHR must follow the same documentation requirements as the paper chart. It is not true that if the information is located "somewhere" in the EHR, that it may be counted toward the documentation requirements for any and all dates of service. The provider must reference within her note for that date of service if she has reviewed any information within the EHR to get credit for the information.

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In This Issue
Excision or Repair?
Get Paid for Post-op
EHR Documentation


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