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  1. R

    I need Help Coding Intestinal Bypass??

    I would think that the mention of using a GIA stapler to create and end to end anastomosis between ileum and transverse colon would suffice as an ectomy. In addition, this service does not state that two small bowel areas were connected the op note said the colon and small bowel were connected...
  2. 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...
  3. 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...
  4. R

    Resection of colon and colostomy revision

    how did you end up coding this op note?
  5. 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
  6. R

    Repair of left ventricular aneurysm

    I thought 33548 is only used if the heart is restored to it's normal shape? The note doesn't talk about reshaping the left ventricle only suturing a patch. My concern is that I'm going to over code this service.
  7. R

    Excision of pilonidal cyst with rhomboid flap

    Hello can someone please confirm.
  8. 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...
  9. R

    Excision of pilonidal cyst with rhomboid flap

    Hi Coding King to clarify your post are you saying 11772 and 14000 can be reported separately?
  10. R

    Excision of pilonidal cyst with rhomboid flap

    thanks for your reply but I'm wondering how you came up with this answer? if you check the codes against CCI they are not bundled. I understand the cpt guidelines state not to separately report excision of a benign or malignant lesion however the codes are listed as 11600-11646 or 11400-11446...
  11. 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?
  12. 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?
  13. 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
  14. 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:
  15. 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?
  16. 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...
  17. R

    96450

    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?
  18. 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...
  19. 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
  20. 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...
  21. R

    Cabg done with a 36556

    Take a look at the website below; http://www.sts.org/sites/default/files/documents/pdf/STSCodingNews-Summer2004.pdf it's out dated but I believe the rules still apply. Hope that helps. Intra-operative services included in the cardiothoracic surgical packages (if services are provided during...
  22. 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...
  23. 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...
  24. 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...
  25. 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
  26. 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...
  27. 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...
  28. 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...
  29. 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...
  30. 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...
  31. R

    Excision of AVF graft

    The reason i hesitate to use that code is that it's for an infected graft which is not the case for this scenario. What I've been doing is coding it as an unlisted 37799 compared to 35903 but I wanted to see if anyone else had a different answer.
  32. 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...
  33. R

    Second request - how to code tracheal hemorrhage?

    Hi there, I dont know if I'm reading this note clearly but I dont see where he entered the tube through the mouth? It sounds like he replaced the tracheostomy tube which I think would be ok to use 31502.
  34. 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.
  35. 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...
  36. 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?
  37. R

    Chest Tube Insertion

    Help anyone??
  38. R

    intraoperative TEE during CABG

    Okay thank you
  39. 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?
  40. 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:
  41. R

    Chest Tube Insertion

    Sorry but I came across a similar sceneraio would we code 32096 32550??? The patient was then placed in the left lateral decubitus position. The skin of the right side of the chest was prepped and draped in the usual sterile manner. A 2 cm skin incision was then performed. The fascia and...
  42. R

    intraoperative TEE during CABG

    Can someone help answer my previous question???
  43. R

    Chest Tube Insertion

    yes your right okay thank you
  44. 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
  45. 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...
  46. R

    Breast excision with reduction mammoplasty

    Yes that's the entire note, so what do you see happened? Which CPT is appropriate for this op note?
  47. 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...
  48. 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...
  49. R

    intraoperative TEE during CABG

    I noticed my doctor does not dictate a separate result note for the TEE he only mentions his findings in the operative report, can we still bill separately?
  50. R

    Cardiothoracic Coding Resources

    Thank you both Sandy and Zuzu I appreciate the help.
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