Wiki Changing the codes

[daedolos]

Has anyone ever had their biller change your diagnosis or surgery codes?

Peace
?_?
I originally coded for a surgery for inflammatory arthritis with radiocarpal and midcarpal and distal radioulnar joint destruction in the right wrist.

I coded 25830-RT

The billing department changed it to 25800-RT, 25240.

 

[iowagirl77]

I worked in billing prior to becoming a coder. I can't imagine changing a surgical CPT unless a coder or provider had advised me to do so. Now that I'm a coder, my coding is sent to the provider for them to sign off on before it gets billed out. Sometimes the provider changes it from what I coded. Is it possible that the provider requested the change?

Susan

 

[mitchellde]

without the operative it is hard to say which is correct, however if the biller did not read the operative note and has no coding knowledge then there should be no allowance for them to change the codes.

 

[daedolos]

without the operative it is hard to say which is correct, however if the biller did not read the operative note and has no coding knowledge then there should be no allowance for them to change the codes.

PREOPERATIVE DIAGNOSIS:
Inflammatory arthritis with radiocarpal and mid carpal and distal radioulnar joint destruction, right wrist

POSTOPERATIVE DIAGNOSIS:
Inflammatory arthritis with radiocarpal and mid carpal and distal radioulnar joint destruction, right wrist

ANESTHESIA:
General

FINDINGS AND PROCEDURE:
This 79-yar-old-male presented with inflammatory arthritis affecting his right wrist. It's destroyed both the radiocarpal and mid carpal and distal radioulnar joint. Because of ongoing pain, he wished to proceed with surgery...

...a tourniquet was placed on his proximal arm and inflated to 250mmHg for 99 minutes. 1 15cm incision was made over the dorsal aspect of his wrist starting over the middle finger metacarpal and moving towards the proximal forearm. The incision was taken through the skin and subcutaneous tissue. The interval between the extensor pollicis longus and finger extensors was identified and developed, and the tendons were retracted. Next, alongitudinal capsulotomy was performed. There was noted to be a large amount of florid dark brownish thick synovium secondary to inflammatory synovitis. This was removed with a rongeur. It was found that the proximal carpal row had eroded away, and was no longer present. The head of the capitate was devoid of all cartilage and had large cystic spaces in it infiltrated with the synovium. The distal articular surface of the radius had a similar condition. A rongeur was used to remove all the inflammatory synovium. Then the rongeur and curet and a bur were used to decorticate the distal radius surface and the proximal aspect of the capitate and hamate.

Attention was then directed towards the distal radioulnar joint. A longitudinal incision made over the distal radioulnar joint to the extensor carpi ulnaris tendon, which was left in place. There was a huge amount of synovitis in the distal radioulnar joint as well which was removed with a rongeur, leaving a very misshapen ulnar head devoid of all cartilage. An oscillating saw was used to resect the ulnar head at its metaphysis neck level. The cancellous bone graft from the ulnar head was then packed into the wrist fusion site. The volar capsule was sutured over the head of the ulna. The dorsal capsule was closed with figure-of-eight sutures with 2-0 Ethibond. Next, a Synthes total wrist fusion plate was chosen with approximately 20 degrees of wrist extension, and this was adapted to the radius and to the index metacarpal with very good apposition and there was excellent compression and contact across the fusion site. The plate was held with two proximal cortical screws and one locking screw and one distal cortical screw and two locking screws. The patient was noted to have a full range of pronation, supination without instability or crepitus of the distal radioulnar joint. Intraoperative x-rays showed good position of the plate and the screws and of the fusion site, leaving the wrist in approximately 20 degrees of extension and slight ulnar deviation. Wound was irrigated with saline solution. Tourniquet was released. Hemostasis was obtained. The dorsal retinaculum was passed underneath the extensor pollicus longus tendon and over the extensor tendons to prevent bowstringing and these were sutured with 2-0 Ethibond suture. Subcutaneous tissue was closed using interrupted inverted sutures of 4-0 Vicryl. The distal skin over the hand was noted to be extremely fragile. Therefore, this was carefully repaired with interrupted sutures with 4-0 nylon and the proximal incision was closed using a running subcuticular stitch with 4-0 PDS. The wound was then dressed with Xeroform gauze and Webril, volar and dorsal below elbow plaster splints were applied and wrapped with more Webril and an Ace wrap...


Peace
@_*
Hope that helps.

 

[AlanPechacek]

I hate to say it, but after reading the Operative Report, most all of the codes "used" for this procedure are incorrect. I will not go into who, how, or why the codes were changed from the Coder to the Billing Department, and/but maybe the physician was consulted in the process. It is not hard to see how the coding of this case is difficult, as the terms/wording in CPT Descriptors are subtly different from each other as it applies to the arthrodesis/fusion of the wrist as done. In the code 25800: Arthrodesis, wrist, complete, etc., the word Complete actually means that the entire wrist was fused from the distal radius and ulna to the carpals. This was not what was done. What was done was 25820: Arthrodesis, wrist, limited, with autograft (utilizing the bone from the resected ulnar head, and which is included in the procedural code) which covers fusion of the Radoiocarpal Joint, only. The term Limited in the descriptor excludes the incorporation of the distal ulna in the arthrodesis. The resection of the Ulnar Head (complete in this case) is the Darrach Procedure, 25240. This is in fact correct.
This case is tricky due to the subtlety of the words used.

I hope this sheds some light and clarifies this case.

Respectfully submitted, Alan Pechacek, M.D.

 

[daedolos]

I hate to say it, but after reading the Operative Report, most all of the codes "used" for this procedure are incorrect. I will not go into who, how, or why the codes were changed from the Coder to the Billing Department, and/but maybe the physician was consulted in the process. It is not hard to see how the coding of this case is difficult, as the terms/wording in CPT Descriptors are subtly different from each other as it applies to the arthrodesis/fusion of the wrist as done. In the code 25800: Arthrodesis, wrist, complete, etc., the word Complete actually means that the entire wrist was fused from the distal radius and ulna to the carpals. This was not what was done. What was done was 25820: Arthrodesis, wrist, limited, with autograft (utilizing the bone from the resected ulnar head, and which is included in the procedural code) which covers fusion of the Radoiocarpal Joint, only. The term Limited in the descriptor excludes the incorporation of the distal ulna in the arthrodesis. The resection of the Ulnar Head (complete in this case) is the Darrach Procedure, 25240. This is in fact correct.
This case is tricky due to the subtlety of the words used.


Got it....thanks for the heads up, doctor.

Peace
@_*