Search results

  1. R

    Repositioning breast implant with flap revision

    Pt completed breast reconstruction as of April 2017, however implant were malpositioned and returned to revise breast by replacing implant, revising dog ear from previous breast reduction, revising flap. Would we bill 19340 with 19380 or only 19340? I'm just unsure if 19380 may be billed with...
  2. R

    Hemothorax drainage via thoracotomy

    skin incision was performed fascia and subcutaneous tissue were entered with electrocautery obtaining hemostasis simultaneously. the pleural cavity was entered, and clots were removed as well as blood. Once clots were removed, the cavity was irrigated. Approximately a total of 1.5-2L of blood...
  3. R

    Lymphazurin Blue Injection

    Is lymphazurin blue injection radioactive? do we code 38900 or 38792? I continue to see different articles stating to bill one or the other during sentinel lymph node biopsy. Any info would help. Thanks
  4. R

    Repair of left ventricular aneurysm

    Hi there, pt is under going a CABG surgery and during the surgery the physician discovers a ventricle aneurysm so he decides to repair it by entering the left ventricle and suturing a pericardial patch to the inner part and healthier part of the left ventricle. How would we code this? I was...
  5. R

    Colostomy Takedown during global period

    Pt is with in the global of a partial colectomy with colostomy and is seen in the office two months later to discuss takedown of colostomy, can we bill the E&M service as unrelated to original surgery? if yes, what dx would we use for the visit?
  6. R

    Excision of pilonidal cyst with rhomboid flap

    Hi there if anyone can please tell me if we can bill an excision of pilonidal cyst 11772 and a rhomboid flap 14000? Please explain when we can bill or why we would not?
  7. R

    45111 vs 44145

    Can someone please help me to figure out what is the different between 45111 vs 44145. They both remove part of the rectum and anastamos the remainding rectum to the colon. Help
  8. R

    Repair of brachial artery aneurysm

    Pt had an old AVF graft excised a few years a go now returns due to pseudoaneurysm in the old scar. Physician reapairs the aneurysm by oversewing and excising the rest of the capsulte. What code can i use for this service? :confused:
  9. R

    Removal of CVP during global

    Pt had an AVF insertion placed and during the global the pt comes in to the office to have his CVP removed due to obsolete dialysis catheter. Can we bill the 36589 and if so what modifier do we use?
  10. R

    Diagnosis for Echo

    We are coding the professional portion for the reading and interpretation performed in the hospital. I was wondering which diagnosis we are to use when coding off the result page? I come across a few that have normal result. I was told we are supposed to use the diagnosis that was written on the...
  11. R


    Can we bill the professional service 96450 in a hospital setting? I cant find anywhere in CMS where we can or cant bill it. Also if we cant bill it is there some other charge we may use instead?
  12. R

    Mediastinal Exploration

    35820 or 33025? in global of cabg however pt sustained cardopulmonary arrest and prompted this emergency procedure. DESCRIPTION OF PROCEDURE: The patient was placed in supine position in her bed in the Intensive care unit. The skin of the chest was prepped and draped in the usual sterile...
  13. R

    Help Keratin Granuloma

    I dont know how to code breast Keratin Granuloma with with ruptured epidormis cyst. Any help with ICD-9 would be appreciated thanks
  14. R

    CPT for blebectomy

    Need Help with CPT Using electrocautery, the soft tissue was divided and entering the pleura, videoscope placed, it was evident that the lung was isolated. There was a large amount of old blood in the chest. Using a thorascope into the incision site the old hemothorax was evacuated and...
  15. R

    33545 vs 33681

    During single vessel coronary grafting the physician also repairs postinfarction septal defect "we decided to proceed with entering the right ventricle. Multiple sutures were placed around the septum, brought back through the septum of the right side. These were pledgeted sutured and placed over...
  16. R

    Skin Flap

    My physician performed a breast mastectomy and in the end of the note he says "We placed a 10mm flat JP drain in the depths of the incision and brought it out via stab wound in the inferior skin flap. We then approximated the breast tissue in layers over the drain in an effort to avoid dramatic...
  17. R

    No hernia sac

    The intent was to repair an inguinal hernia but when entering the area no sac was identified the physician dissected free of the other cord structures and reduced into the preperitoneal space. Inguinal floor was the reconstructed using a precute keyhole piece of mesh. Preop and Post op dx was...
  18. R

    Umbilical Hernia repair

    Physician repairs umbilical hernia and then inserts the port through the defect to complete the cholecystectomy. Ok to bill 47562 49585? if no please explain why not. Thank you
  19. R

    Hernia Repair 49505-50?

    My doctor noted bilateral hernia repair but when reading the documentation the left side was explored with no hernia found. The right was found he notes " no definite hernia sac present" but applies a mesh deep to the spermatic cord. the left side was actually a inguinal hernia repair. Do we...
  20. R

    Aneurysm Repair

    Patient has a left arm Arteriovenous fistula, two issues one there is a stenosis on the cephalic vein portion of the fistula procedure performed "No Glidewire was available so a Benton wire was advanced fistulogram was performed dorado balloon was the parked at vein stenosis it was used to a...
  21. R

    19304 vs 19303

    I have trouble telling the difference between these two codes 19303 vs 19304 " We elevated the skin edges and I dissected the breast tissue free from the subcutaneous tissue down to the pectoralis fascia. Medially we dissected down the pectoralis fascia even with an imaginary line connecting...
  22. R

    Biopsy of Anal Canal

    Under general anesthesia the sawyer retractor was placed there was a hypertrophic anal papilla coming off the left anal column. Local was injected. This was excised using a 15 blade and then chromic was used to reapproximate the mucosa. The was another small anal like lesion on the ana canal...
  23. R

    Excision of breast lesion

    My doctor excised a cyst that was located on the breast he wants to code 11403 but my question is if a cyst is located on the breast or better yet if it is located on the skin or subcutaneous part of the breast do we have a choice between 11403 codes i thought we automatically bill 19120. Any...
  24. R

    Excision of AVF graft

    Help coding below: Any suggestions would be appreciated. :confused: After administration of intravenous sedation, the left arm was prepped with ChlorPrep and drapped. A small oblique incision was made over the arterial limb of her forearm loop graft where she is having pain. The graft was...
  25. R

    Revision of reconstructed breast

    Can we use CPT 19380 for patients with no history of breast cancer. pt had a breast reduction and is complaining of breast pain so the physician reconstructs the breasts.
  26. R

    Bilateral Breast Excision

    Help do we code both 19120 & 19318 The patient was anesthetized in the supine position and the chest was prepped and drapped. The nipples were realigned with a cookie cutter at 42 mm diameter. The irregular scar tissue around it was excised on both sides, including most of the vertical...
  27. R

    Removal of Hernia Mesh

    pt comes in for a recurrent hernia repair with insertion of a new mesh, is there a code to remove the old mesh? is this considered bundled, if it's not bundled what is your source to remove the old one?
  28. R

    malfunction of CVP during global

    patient had a cabg on 3/1 then on 3/2 pt had a return to the OR due to mediastinal bleeding then on 3/3 pt had a swan ganz placed and cvp due to malfunctioning CVP in her bedside...are we ok to bill the services performed on 3/3? would we consider this urelated?
  29. R

    VATS w/ washout of hemothorax

    After entering the chest through a video scope the chest was entered and noted to be copious amounts of old blood in the chest: the chest was irrigated and 3 liters of irrigation through pulse lavage with vanocomycin. How would we code this?? Help:confused:
  30. R

    Chest Tube Insertion

    if the physician performs a sternotomy lymph node biopsy and proceeds to place a chest tube to the level of the incion can we code both: 39010 32550
  31. R

    Incision and drainage Perirectal Abscess

    Need help with CPT :confused: The patient was flipped to the prone position and perineum was prepped and draped in sterile fashion. Final time out was done. Digital rectal examination was done and no mass or any defedts were noted. the anoscope was introduced into the anal canal, there were no...
  32. R

    19300 vs 19304

    Male patient dx gynecomastia bilateral What cpt would we use for this service I came up with 19304-50 & 15877 but can we use 19304 on a male patient? Do we have to default to 19300? The breast tissue from the right side was excised using cautery taking everything from subcutaneous fat down to...
  33. R

    Breast excision with reduction mammoplasty

    Help do we code both 19120 & 19318 The patient was anesthetized in the supine position and the chest was prepped and drapped. The nipples were realigned with a cookie cutter at 42 mm diameter. The irregular scar tissue around it was excised on both sides, including most of the vertical...
  34. R

    Laparascopic Proctectomy

    How would we code Laparascopic sigmoid colectomy, proctectomy with coloanal anastamosis without Jpouch with diverting loop ileostomy?
  35. R

    Date of surgery

    if the physician started surgery on 1/1 but finished on 1/2 what date do we use as the date of service, CMS says we use the date the service was furnished..does furnish mean complete or day it initiated?
  36. R

    Hemicolectomy with Brooke ileostomy

    doctor removed cecum, ascending colon, up to transverse colon, part of terminal ileum was resected to create a brooke ileostomy. What CPT do we use??? Help please
  37. R

    Aorta Left common carotid bypass

    how would we code for this, doctor also performed aorta left subclavian bypass, and right subclaivan
  38. R

    Endovascular AAA repair w/ extender

    If the physician is concerned the stent may be too short and applies an extender can we still bill separately? Does the note have to say endoleak to justify medical necessity for the extender 34825?
  39. R

    Hemicolectomy w end Ileostomy

    How would i code this. The problem that I see is that it doenst look like the terminal ileum was removed. Doc says the ileum was clean and viable the ascending colong was removed, ileostomy was broght out mid abdomen excising a core of skin and subcube fatty tissue incision was made in the...
  40. R

    Intraaortic balloon pump during CABG

    Can we bill separately for the intraaortic ballong pump via femoral artery during a CABG?
  41. R

    intraoperative TEE during CABG

    Can we bill for a transesophageal echo during a CABG, what code would we use if we can. I checked STS and did not see it was one of the inclusive global procedure.
  42. R

    excision of axillary aberrant breast

    What cpt would we use for excision of axillary aberrant breast and what dx would we use if the path report says axillary fat pads, ok to bill 19120?
  43. R

    Myocardial Infarction in office setting

    Patient is with in 8 week of intial myocardial infarction and presents to the office for follow up, what DX do we use??
  44. R

    Laparascopic low anterior resection end colostomy

    44208 vs 44206 or ??? DESCRIPTION OF PROCEDURE: The patient was brought to operating room and placed in the supine position under general anesthesia and intubated. The patient's abdomen was prepped and draped in sterile fashion and placed in low lithotomy and a final time out was done...
  45. R

    removal of terminal ileum

    The physician removed the terminal ileum and transverse colon and performed an end to end anastamosis, NO Colosotomy via laparascopic, what CPT would we use?
  46. R

    VATS decortication w/ Pleurodesis

    Can we bill 32650 and 32651 if performed during the same setting, if no why not?
  47. R

    Interval History - What does interval history mean?

    What does interval history mean?? If the physician documents 2 out of 3 in his subsequent note but does not note a CC or HPI is the visit billable?
  48. R

    Porta Hepatis Lymph Node Biopsy

    How would we code porta hepatis lymph node biopsy during a distal gastrectomy????
  49. R

    Open Lobectomy with lymph node dissection

    If the physician dissects the R4 Lymph node during the lobectomy would that qualify to use CPT 38746 or would it be incidental?
  50. R

    Excision of brest with properative wire

    If the excision involved a guidewire not a planted radioactive seed can I still code 19125? This is a big debate for us here.