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  1. M

    Therapeutic scuba diving for PTSD

    Ok just throwing this out there. I have a friend that is trying to help a scuba shop set up a program for PTSD patient to take scuba lessons. They have several patient lined up with referrals. . They mostly have TriCare and I think one has BCBS . She is looking to see what CPT code would best...
  2. M

    99231 rounding visit.

    When our Dr. round on patient does there need to be a exam everytime. The may be checking to see how the patient is feeling and my go over test results or my order test. I work for general surgery dr. They consult the patient and if they do not need surgery at that time the may order test and...
  3. M

    LAR with Ileostomy

    This always confuses me. When our Dr. does a Lower Anterior Resection sometimes he will do a Ileostomy on the other side, not a colostomy. So is it still the same as 44208 or is it 44207 and 44310 ? Thank you, Marie
  4. M

    Inguinal exploration, no hernia

    I am just not sure on this on. No hernia was found. He just did exploration. Thanks for any input PREOPERATIVE DIAGNOSIS: Recurrent right inguinal hernia (ICD-9 code 550.9). POSTOPERATIVE DIAGNOSES: 1. No evidence of recurrent hernia. 2. Hydrocele. PROCEDURE PERFORMED: Right inguinal...
  5. M

    lap partial cecectomy

    Help please, Not sure on this one it not a true rt colectomy 44205 . He only removed a corner of the cecum. Report as follows. INDICATIONS: This pleasant 71-year-old patient of Dr. _____ was referred to my office after undergoing screening colonoscopy which revealed a serrated adenoma of the...
  6. M

    Any info on LexiCode ?

    Hi gang, Does anyone work for or have worked for LexiCode. I have seen several nice looking ads from them. I was looking for a outpt. remote job and this always looks appealing. I would appreciate any input. Thank you, Marie
  7. M

    Exc of Schwannoma with nerve grafting

    I have never seen any thing like this one. The patient was brought to the OR and placed under MAC anesthesia and the right leg which had been marked in holding was prepped and draped in the usual sterile fashion. The lesion was located on the lateral tibia about 20 cm proximal to the ankle and...
  8. M

    Intraabdominal FB (IUD)

    I need help please on this one. Not sure how this could happen, but the patient had a IUD that became disloged and was in the abdominal cavity. The patient was brought to the OR and placed under general anesthesia. The arm was prepped and draped in usual sterile fashion. A 10 mm and 5mm port...
  9. M

    Abd all wound exploration

    I see this from time to time and just not sure how to code this. This is a 52 year old male who underwent a sigmoid colectomy for diverticulitis. His midline wound has all healed except for a small opening below the umbilicus. The patient was sterilely prepped and draped . A incision was made...
  10. M

    Intraabdominal foreign body (IDU)

    I need help please on this one. Not sure how this could happen, but the patient had a IUD that became disloged and was in the abdominal cavity. The patient was brought to the OR and placed under general anesthesia. The arm was prepped and draped in usual sterile fashion. A 10 mm and 5mm port...
  11. M

    PEG tube removal in the OR

    We have a patient that needs his PEG tube removed. Refused to have it done in the office. Our Dr. took him to the OR and under sedation removed the PEG tube. Any thought on how to code this one, Thanks, Marie
  12. M

    Repair pseudoaneurysm of anterior tibial artery

    Sometimes the ones that seem so easy I cant seem to figure out. My Dr. does this procedure alot on the common femoral, but this was in the ankle and he did the tibial artery. Any ideas? PREOPERATIVE DIAGNOSIS: Right foot pseudoaneurysm of the right anterior tibial artery. POSTOPERATIVE...
  13. M

    Lower anterior resection with ileostomy

    Help Please, When our Dr does a open lower anterior resection with diverting loop ileostomy do we use the 44145 and 44310 or the 44146. The 44146 is with colostomy would that also be for a ileostomy? Thank you, Marie
  14. M

    Colovaginal fistula repair

    Help please. I have no idea on this one. Patient remained in modified lithotomy position. Her abdomen and perineum were prepped and draped in sterile fashion. After local infiltration, a supraumbilical incision made, pneumoperitoneum achieved with a Veress. A 12 mm bladeless trocar was then...
  15. M

    Diag help please

    My Dr. went in to check a screw for bowel penetration after repair of a hip fx. There was nothing found. Not sure what diagnosis code to use. Op-Note to follow PREOPERATIVE DIAGNOSIS: Right hip fracture with question of pelvic penetration of screw. POSTOPERATIVE DIAGNOSIS: Right hip fracture...
  16. M

    Wound care coding resource.

    I work with a group of general surgeons. We have one that is now going to a wound care center. Is there a book or a good website for help coding wound care. Thank you, Marie:rolleyes:
  17. M

    Median arcuate ligament syndrome

    Help please. I have no idea on this one. The patient has some kind of celiac artery occulsion. Op note reads : An upper midline incision was made and the abdominal cavity was entered and the lateral attachments of the left lateral segment of the liver were taken down with the cautery and the...
  18. M

    Help !! Divison of median arcuate ligament

    I need help with this one. Cant find anything for this procedure. Division of median arcuate ligament. Our Dr. has not done the procedure yet thay want a code for pre-cert. I dont even know what unlisted to use or what a "like" code would be. mg
  19. M

    Open ing hernia repair excision of cord lipoma

    Help please. We have a surgeon that that keeps insisting there is a code for removal of a cord lipoma when he does a inguinal hernia repair. Op not will read; Care was taken to identify and protect the ilioinguinal nerve from harm. The cord structures were carefully isolated at the pubic...
  20. M

    Laparotomy sigmoid - I hope someone can assist

    Good morning, I hope someone can assist with this one. I was looking at 44320 for the Colostomy, but the Dr. did a mesh reinforcement a Sugar Baker Tech. and he said there is a code for that procedure. Any ideas? PROCEDURE PERFORMED: Laparotomy with diverting end sigmoid colostomy and biologic...
  21. M

    Lap sigmoidectomy, repir of bladder fistula

    Help please. This is a lap sigmodectomy and repair of colovesical fistula. I'm looking at 44204,44213 but having trouble with the fistula repair. The code 45800 for closure of rectovesical fistula is open. Any idea's. Op note to follow. Patient remained in modified lithotomy position. Her...
  22. M

    lap Paraesophagel repair outpt.

    I need some help on this one please. Our Dr. did a lap paaesophgel hernia repair with mesh and we billed 43282. This was done as a out patient. The hospital face sheet has the patient as a outpatient. The insurance in denying saying this is only a inpatient procedure. Any ideas? Marie
  23. M

    Reclosure of hernia mesh

    I need help on this one please. Dr. did a lap ventral hernia repair in the am, then patient developed a intra-abdominal bleed. So the same day he went back in. This is how the op note reads. Exploration and reclosure of prior placement of hernia mesh. Trocar sites were reopened, ports were...
  24. M

    Subtotal Colectomy

    I need some help please. One of our Dr. did a "subtotal colectomy". I reading the op note he removed all of the colon except the rectum. He also did a ileostomy. Can I bill 44140 and 44160 ? or is there a code that covers both sides rt and lt. Not a total as he left the rectum. This was a open...
  25. M

    S2900 help please

    I posted this on the General Surgery forum but I know sometimes this code is used in urology. Does anyone have any more/other info on S2900. I have a general surgeon that is using the Robotic assist in some colon resection cases. I know it is not recognized by Medicare and some other payers...
  26. M

    Supraumbilical hernia repair

    For a Supraumbilical hernia repair would it be umbical rpr 49505 or I heard somewhere that it should be ventral repair 49560. Thank you, Marie
  27. M

    Help with S2900

    My surgeron was speaking with another Dr. and he said he uses S2900 for: Surgical techniques requiring use of robotic surgical system. He sayes he uses the robotic assist with Ventral Hernia repair. Any thoughts on this ? Is there somewhere to look up more of a description of the code? Thank you...
  28. M

    Lap Hiatal hernia repair

    Ok I am brain dead. I haven't had one in a long time. Which code do we use for lap hiatal hernia repair. I look at the new code 49652 that doesn't look correct. Are we still using the unlisted code ? Thank you, Marie
  29. M

    wide excision ance conglobata

    I need help with this one please. Dr did this at the am surg. The pt affected area on the lt medial thigh was maked out with a making pen and then scored circumferentially with a scalpel. Dissection was then carred deeper using cautery. The entire area was then comletely removed from the...
  30. M

    Excision MM back 21935 vs 1160X &1203X

    Please help I know I have seen this before. This is a big debate in our office. Dr does an excision of a malignant melanoma of the let say back. He will dictate and say " down to the fascia". not INTO the fasica, but down to... I thought it would be the 1160X and 1203X if into the fasica we...
  31. M

    Hematoma evac following mastectomy help please.

    I need some advise on this one. The Dr. did a mastectomy and placed a drain. While the patient was in recovery showed bloody drainage.He took he back to the or removed the staples and removed a clot , irirgated and closed the drain. He placed a new drain. Thank you for your assistance. Marie
  32. M

    residual BCC ?

    I work for 13 general surgeons. One does alot of excision of lesion ect.... I see alot where a patient will come in for a consult from a derm dr. where the had a bx and have BCC or a malignat melanoma. Our dr. looks at thier path for the diag. and then removes either in the office or the OR the...
  33. M

    Stereotactic breast question

    Not sure what to do with this one. Pt presented for stereotactic breat bx. Pt was placed on the table, breast suspended through the aperture. Multiple attempts were made to localize the abnomality. The pt has very small volume of breast tissue and the localizing coordinates were not suitable for...
  34. M

    Ileocolostomy distal ileum and sigmoid colon

    I need help on this one. Dr. did a bypass an ileocolonic anastomosis. This patient apparently has extensive cancer. He did not remove the colon, just bypass the area of obstuction with an anastomosis of the ileum to the sigmoid colon. Can I still bill 44160 even though he did not actual remove...
  35. M

    reduction of stomach, closure of crura, gastropexy

    Help please. I am total lost on this one. The op not read: first he does convert to open. The hepatogastric ligament was then incised. This was continued up to the hiatus which the stomach was identified. Starting at the right crura the loose areolar tissue was incised. This was continued down...
  36. M

    Multiple phlebectomies help please

    Could somone help me with the difference between 37765 and 37785 I'm new to this section and not sure how to decided between the two. The Dr op note reads: The patient was placed in a prone position. The right leg was sterilized and prepped in usual fashion. Using a total of 7 separate...
  37. M

    Intraoperative consult code ?

    Could someone please let me know how to bill for an intra-operative consult. We have run across 2 different cases. 1. would be if our Dr was call in during surgery for a consult on something and no surgery was performed by our Dr. 2. would be when like the one I have now where our Dr was...
  38. M

    Removal of PICC line - My brain has left me today

    Good morning, My brain has left me today. Could someone please tell me if there is a code for removal of a PICC line. The Dr. will be doing this in the office and they need a code for the referral Thank you meziesky
  39. M

    Help with: Infected mesh from prior hernia

    Could somone please advise me on this one. Dr removed infected mesh from previouse ventral hernia and did a ventral hernia repair. The prior surgery was done more than a year ago. Is there a code for removal of the infected mesh or do i just bill out the ventral hernia repair. Thank you meziesky
  40. M

    Breast help please

    The Dr is doing a Mastectomy 19301 and axillary excisional LN bx. He wants to bill 38740. This is a breif discription: Made a incision in the axilla , dissection was carried down to the axillary fat pad proper where a enlarged, suspicious node was identified. It was separated from surrounding...
  41. M

    Help with lap pancreatectomy

    Help ! This is a good one. Could someone please advise me on this. Dr removed a tumor : laparoscopic pancreatectomy , splenectomy and en bloc partial adrenalectomy. Thank you for any help you can provide Meziesky
  42. M

    Help with exc of malignant fibrous histiocytoma

    Could someone please advise me on this one. This is a re-excision. Not sure when the 1st procedure was done. It had to be more than a year ago. Op not reads: The probable recurrence of the MFH was located along the medial aspect of the elliptical skin incision and involved a portion of the skin...
  43. M

    IVC Filter help.

    I need some insite to IVC filter placement and removal. The surgeron and his nurse seem to think this is a standard set of code that are always the same. They want to use 37620, 75940,26 and 75820, 26 always for insertion. I was told by a fellow coder it should be 37620, 36010 and 75940,26. For...
  44. M

    Excision malig. melanoma 11640 vs 27615

    I seem to run into this alot. Wide local excision of maligant melanoma of left leg. I have trouble between the 11640 codes with layered closure and the 27615 code. I see this alot and the Dr. always want the 27615 code. His op notes read: Both were excised after delineating an elliptical...
  45. M

    Rescection, colon, tail of pancreas, spleen, and lt kidney

    Help please. This is a new one for me. Can I use 44160 for the colon resec. and 48140 for the pancreas ??? An en bloc resection of the primary tumor, including hepatic flexure of colon, tail of pancreas, spleen, and left kidney was then performed. The pancreas was taken first with a TA-60...
  46. M

    Breast help please

    Ok, this is a new one to me. This pt had left breast cancer 20 years ago. Had a mastectomy with reconstruction and implant on the left. Now with a bx showed left chest wall invasive ductal carcinoma and positive on the rt. for lobular carcinoma. The Dr did a Right mastectomy, but here's the...
  47. M

    How to find local worshops

    Does anyone know how or where to look for local workshops? I'm sure there must be a list somewhere. Thanks Marie:confused:
  48. M

    colostomy reversal

    I need help. Which code do you use for a colostomy reversal ????:eek: MEZIESKY
  49. M

    Lap resection of stomach

    I'm new to coding general surgery. Could someone please help me with a lap resection of distal stomach and proximal duodenum with Roux-en-Y gastrojejunostomy. The diag is adenocarcinoma, duodenal bulb area. Also does anyone know of any good resources, books ect. for gasto/colon coding. I did...
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