Wiki Excision & repair coding sequence

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hbarclay@portlanddermclinic.com

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Just starting out with my CPCD coding course. I've been working on the practice case studies, and I'm finding that a lot of the repairs are being stated as the "first CPT listed". When reading the case studies, the first CPT listed was (what I thought would was) the procedure of the excision itself. What is the sequence of CPT codes listed when coding an excision and repair for example? Are repairs always going to be listed before the procedure itself? Also, where would I find these guidelines stating the info I'm looking for? Thank you!
 
I don't think there is any rules about repairs vs. excisions being listed one before the other on claims.

Ideally, on claims the following code order is recommended (but not required).

1. E/M services listed first
2. Surgical procedures listed from highest to lowest Relative Value Unit (RVU). Often times Repairs have higher RVUs than excisions (but not always)
3. After that, opinions may vary. Personally, I recommend placing pathology/radiology next and lastly, listing injections/J-codes.
 
AAPC course and practicode (CPC) both teach coding any and all CPT codes by RVU value, highest to lowest (to the point they mark answers wrong if not coded by value).

So, I gather this is not required for payment "in the real world?"
 
Remember that certain procedures, and this would be mainly surgical procedures (10000-69999 CPT codes), are subjected to discounting. The first procedure pays at the full fee and the second and subsequent discount. Now the way it should work is the higher RVU should be the one that pays at the 100% rate, however in practice most payers have the system set to pay 100% of the one listed first and discount the second and subsequent. For this reason we do teach to code the higher RVU codes first ( but we really mean the higher RVU surgical CPT codes), and the subsequent in descending RVU order. This can be confusing when it comes to modifiers. Some teach to use the modifier on the second CPT code(s). In reality you want the modifier to do its job, and if you append it to the incorrect code it cannot do what you need. So the modifier needs to append to the code that would be considered bundled, and sometimes due to the very weird way they assign RVU values the modifier will be on the first listed code as that is the one with the higher RVU, but it is also the one that would be bundled. Sometimes you cannot find the logic, you just have to roll with.
 
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