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  1. J

    Drainage catheter injection

    I need help with this, I have a biliary drainage catheter that was just injected, no other intervention performed. I can't seem to find a code for this. Here is the ope report: A pigtail 14 French drainage catheter is seen along the right lateral abdomen on scout imaging. Numerous internal...
  2. J

    Oddly titled report

    So I have a report that is titled as an xray ap+erect+chest 1 view, but it's referencing contrast, so I'm not sure how to proceed. Here's the entire thing: FINDINGS: Scattered small bowel and colon gas. There is an air-fluid level in the stomach. No dilated bowel. No intraperitoneal free air...
  3. J

    Basic radiology question, shuntogram S&I

    So I've got a question about shuntograms. My radiologists do the radiological interpretation all the time, but I'm not sure if that's enough to bill 75809. They do not do the injection procedure. Here's an example of the entire report I just received. PROCEDURE: XR SHUNTOGRAM IMAGING HISTORY...
  4. J

    Complicated attempt at coil retrieval

    Here is the op note: I haven't seen anything like this before, so I was hoping to get some ideas from all of you. Thanks! Procedure: 1. Bilateral pulmonary angiogram. 2. Attempted coil retrieval TECHNIQUE: A 7 French sheath had been previously placed in the left arm fistula. This was exchanged...
  5. J

    Abdominal Aortic Stent Grafting - Number of limbs?

    So I want to just check in with you all on this, and make sure I'm understanding and coding these correctly. Here is an example of a typical report I receive, please give me your opinions on CPT codes and how you determined the number of limbs. It seems like my docs are calling things "limbs"...
  6. J

    Mesenteric Angiogram

    These are still really confusing me! I'm still learning, but I have no resources and have had no training on when to use selective vs. non-selective codes, and which arteries are covered as first, second and third order. I've come a long way since I started working these, but still have a lot to...
  7. J

    Removal of cholecystostomy tube

    I cannot find the CPT code for this! Anyone have any ideas? Done by interventional radiologist.
  8. J

    attempted declotting of loop graft

    So here's the report. Any help is appreciated. "The right forearm Gore-Tex loop graft was accessed in both antegrade and retrograde fashion with 21-guage micropuncture needles. The access needles were exchanged over guidewires for short 6 French sheath. Through each sheath, a 5 French Kumpe...
  9. J

    Nasal Embolization help

    I am newer at interventional radiology, and I need help with this case. Any help is greatly appreciated. Thank-you! "The right groin was prepped and draped in a sterile fashion. Local anesthesia was applied. Under ultrasound guidance, the right common femoral artery was punctured. A short 6...
  10. J

    Antibiotic nail placement femoral canal

    I am trying to figure out what the best CPT would be for the antibiotic nail placement into the femoral canal. Op report says: "Antibiotic bead string was identified. Beads were removed in their entriety. Canal was extensively irrigated. An antibiotic nail was mad with a guidewire small...
  11. J

    resection arthroplasty with antibiotic bead placement

    This one was new to me, so if anyone can help with CPT, I would appreciate it a ton! "Posterior aspect of hip was exposed by elevation of granulation tissue and transection of short external rotators. Hip capsule was identified and incised in a T fashion. Femoral neck was osteotomized with...
  12. J

    Placement of venous infusion catheter

    Here is what I am looking at, haven't seen this before, so any help is appreciated: "Under direct ultrasound guidance, the left popliteal vein was percutaneously accessed with a 21-guage micropuncture needle. The access needle was exchanged over guidewire for a 6 French sheath, through which...
  13. J

    2nd opinion cervical hematoma evac

    Pt. had an anterior cervical discectomy, and then post-op developed a hematoma in that area. The op note states that "his previous anterior cervical discectomy wound was reopened, hematoma was evacuated, a TLS drain was placed in the surgical bed and tunneled through the skin inferiorly. They...
  14. J

    Craniotomy question

    I have the following op report, and I'm very new to this specialty, with very little guidance, so any help is greatly appreciated. ...his head was placed in Mayfield head holder and turned to the left exposing the right side of his head. Neuronavigation system was then registered. Once...
  15. J

    Circumcision revison and Z-Plasty

    I need help on this one, because I'm not really sure which code to use. I was thinking possibly 54163, but doc says 54001, and I'm not really very familiar with these codes at all, so any help is Greatly appreciated! Here's the op note in part: ....He had significant phimosis. A dorsal and...
  16. J

    Open tibiotalar repairs

    I need help! Here's the op report: ....Skin incision only then down with blunt dissection to the capsule. After this, inspection of the tibial talar region revealed abundant hypertrophic synovium which is debrided. Also evidence of a large spur on the anterior distal tibia which was debrided...
  17. J

    Medicare diagnostic colonoscopy issue

    Hey everyone, if you have any resources I can use, I'd sure appreciate it! I have 5 claims from 2009 that Medicare went back and reprocessed, all for diagnostic (not screening) colonoscopies. They said that the reason for reprocessing and denial was because there was a frequency issue on all of...
  18. J

    Enough info to code anterior fusion?

    I am not sure I have enough info to code a fusion. Input appreciated. Here's the info I have: ...Retroperitoneal exposure to the anterior lumbar spine. Following the exposure, the fluoroscopic C-arm was brought in to confirm levels. Discectomy was then performed with removal of the anterior...
  19. J

    Another spine question. Sorry

    So I have a procedure where the doc did a posterior interbody fusion of L4-5 and L5-S1. But later after he documents laminectomy and discectomy with this, he documents placement of pedicle screws bilaterally at L4, L5, and S1, then he does a rod placement, and documents sponylolisthesis...
  20. J

    63030?

    The doc says this is 63047, but I don't see that. So I'm just checking what everyone else thinks. Thanks again for the help. (these spine questions will slow down as I get more acquainted!). Op report: ...Fluoroscopic C-arm was brought in to confirm starting point. Dissection is carried through...
  21. J

    confused on laminectomy codes

    I'm confused because in some cases it looks to me like I should be using only the 63001-63005, which is Laminectomy with decompression without facetectomy, foraminotomy, or discectomy. But it seems that most people are using the 63045-63048 codes, which would include facetectomy and...
  22. J

    Extreme rookie at spine coding

    I'm taking over some spine coding, and none of my other ortho docs do spine, so I'm at that fun place of less than sure what I'm doing-ness. Please help! :0) Here's the note: ...A midline incision was then made centered over L3 to L5. Dissection was carried through the skin, subcutaneous and...
  23. J

    Sphincterotomy with Botox?

    deleted post I found what I was looking for.
  24. J

    granuloma troubles!

    I appreciate any input you all have. This is the first report like this I've come across, and it's making me crazy! The note says: The granuloma with a chronic lined tract is excised completely down along the anterior abdominal wall, coursing posteriorly and superiorly. The entire tract, which...
  25. J

    Not alot of documentation

    Here is what I have to work with. Argh! A transverse incision was reopened. A sinus tract was followed down to mesh which was removed. After thoroughly irrigating the area and noting no bleeding, 3 liters of ascites were removed from the peritoneal cavity. The soft tissue was approximated with...
  26. J

    Bowel resection with hernia repair

    I have a very small section of bowel that was removed within the course of a hernia repair. How would you code this? I am not sure whether to consider it incidental, and the notes aren't great. Please help. ...Visiport was used to gain access to the peritoneal cavity. Under direct vision...
  27. J

    Hartmann or mucofistula?

    My doc's notes are sometimes less than wonderful. Please help me decipher this one! Thanks! ....Stool was disimpacted from the rectum as best possible as literally hard as a rock. The laparoscope was placed, and under direct vision it was noted that in the cul-de-sac region, there was a...
  28. J

    Need help!

    Here's the note: .....a transverse incision was made over the marked side of the bulge in the abdominal wall. Eventration of mesh into an old hernia sac was noted without actual herniation or recurrence. As the mesh was a bit redundant in that location, it was imbricated back into the...
  29. J

    Inguinal scar excision- Please help!

    I cannot figure this one out, I keep going back and forth, so any help is appreciated. Here's the note: Name of Operation: 1. Lysis of painful scar, right groin. An incision was made reopening the old scar. Scar tissue from two incisions were both lysed completely surrounding the cord...
  30. J

    Reanastomosis and lysis

    Okay, so if you can decipher this, you're doing better than me...please help! Op note: ...Visiport was used to gain access to the peritoneal cavity. Additional trocars were placed along the axillary line. The small bowel was run from the sigmoid valve to the ligament of Treitz. It was obviously...
  31. J

    postop bleeding control procedure

    Patient had a sig resection the day before, and came back with anemia that was uncontrollable. The doc decided to re-open, and here's the notes: The old trocar sites were reopened. The abdomen was systematically explored, and approximately 300 ml of clotted and non-clotted blood was removed...
  32. J

    Infected Mesh Removal - FLANK

    Doc did a removal of infected mesh, down to fascia and deep muscular tissues of the left flank. No debridement indicated, wound was packed. Please help - need cpt. Thanks for the help!
  33. J

    strange liver biopsy`

    Please help, I'm not sure where to go for this one. Thinking possibly unlisted, but I'd rather avoid that if I can. Maybe I should go for something else? Please help if you can. "The patient underwent prep, drape, and time-out per Joint Commision guidelines. Access was gained into the...
  34. J

    47740?

    Ok, so here's the op report, I'm not sure on this one, so help is greatly appreciated! "No palpable mass in the head of the pancreas area is noted. There is some thickening of the tissues in this area due to recent placement of the common duct tube. There was a fairly significant enlarged lymph...
  35. J

    Peri-anal mass excision

    I cannot for the life of me come up with a code that I feel comfortable with on this one, so any input is greatly appreciated. The op note says: " Externally at the 7 o'clock position, there is a thick induration and a small opening in the skin. When squeezed this area there was clear fluid...
  36. J

    Question on 52630

    My doc wants to code this as a 52630, but I'm not sure if this is correct, and I need a little outside help! Thanks guys! "A 24-French loop was then used to cut a channel through the prostatic stricture and into the bladder. The prostate was then resected removing essentially scar between 6...
  37. J

    Loop prostate biopsy

    So I'm super new to urology, so sorry if this is a kind of dumb question, but does anyone know the cpt for "the prostate was biopsied taking a deep loop cut at the distal right lobe above the verumontanum"? I need help! Thanks for any input. I came up with 55700, but the whole loop thing is...
  38. J

    Tough Report-Please help!

    I don't know why I'm having such a hard time with this one, but if you can help, I'd very much appreciate it! Name of Operation: 1. Extensive debulking of tumor from pelvic floor. 2. Sigmoid colectomy 3. Resection terminal ileum and cecum with primary anastomosis and colostomy, closure bladder...
  39. J

    Questionable hernia repair

    I know I'm probably overthinking again, but I wanted to get other opinions before I send this one off. The doc says it's an abdominal wall hernia repair, but to me, it doesn't seem like they really did much with the hernia itself. So here's the op note. A vertical incision was then made. The...
  40. J

    2 colectomies

    I have a report where the doc did multiple resections of multiple sections of the colon. He didn't perform an anastomosis until the last one was done though, so I'm thinking I can't code both. Any help is appreciated. Here's part of the report: The cecum and ascending colon were volvulized and...
  41. J

    Small intestinal Fistulectomy

    I need help on this one! Can't seem to wrap my head around it. Thanks for any help. OP report says: Dense adhesions were _____Metzenbaum scissors. Multiple loose of bowel and colon were matted in inflammatory mass in the pelvis adjacent to the vagina. After taking these loops of bowel off of...
  42. J

    little finger fracture care

    I have a doc who did the following, and I need help! :o) Small incision was made over the dorsum of the base of the little finger metacarpal through the skin and subcutaneous tissues retracting the extensor tendon laterally to the base of the metacarpal once opened up with an awl. Following...
  43. J

    resection w/colostomy and ileostomy

    Need help! Doc says they want to use 44206, don't think I agree. It was done laparoscopically. So here's part of the note: Sigmoid was taken down from the peritoneal reflection in the pelvis to the left colon and removed between GIA staple lines. The distal colon had normal mucosa actually...
  44. J

    don't get it! Multiple hernias.

    I have been doing general for only a little while, and I really need some guidance on multiple hernia repairs done during the same operative session. It seems like there is a lot of conflicting info out there, so please help! Here's an op report I'm not sure what to do with: A midline...
  45. J

    Hand Surgery, Need Help Please!

    I am not good at hand procedures, and I need some help. Thank you in advance for the help. The op report says that the procedure performed is: 1. Relesase of right hand ring finger, little finger, index finger trigger finger. 2. Limited release of long finger trigger finger remnants of the A1...
  46. J

    Incarcerated hernia coding guidance

    I'm looking for some guidance on how you can determine if a hernia is truly incarcerated. I have some reports that say that the sac contains incarcerated omentum, but they were able to reduce the hernia, does that mean it's not considered an incarcerated repair? I'm feeling very hazy on my...
  47. J

    Need Help with hand procedures, A.S.A.P. :0)

    ok, so I'm just going round and round with myself trying to figure this one out, so if you guys could help me, I'd so much appreciate it! The procedures performed were: Decompression of the flexor sheath to the right index finger Decompression of the thenar and middle palmar spaces Division of...
  48. J

    Shoulder coding - 2nd request

    Here's the op note in part: The arthroscope was directed into the glenohumeral space revealing evidence of aterior inferior labrum degeneration, small tear at the 7 o'clock to 8:30 position. Add portal was made superolateral to the coracoid, where VAPR wand was used to debride and smooth out the...
  49. J

    Shoulder of course - Capsulotomy?

    Here's the op note in part: The arthroscope was directed into the glenohumeral space revealing evidence of aterior inferior labrum degeneration, small tear at the 7 o'clock to 8:30 position. Add portal was made superolateral to the coracoid, where VAPR wand was used to debride and smooth out the...
  50. J

    47480 laparascopic equivilant

    I need help! I can't find a lap code that satisfies the same criteria as 47480, which is the procedure that the doc did, but it was done laparascopically. We billed it to mcr with an unlisted code, and documentation, and they said that there is a better code. Anyone have any ideas? Thanks!
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