does anyone know if an exploratory lap (CPT 49000)can billed with modifier 59 on trauma pts (gunshot wound, auto accidents) in addition to the other procedure(s) such as liver repair, spleenectomy, small or large bowel resects?* I have been told that when it is a trauma that requires an emergent exploratory lap it can be billed with the 59 mod in addition to the procedures needed to be performed.* I have read NCCI edit manual and I interpert this as No, but am told differently. Also,I am told that the physician must state that the entire bowel was run. I would appreciate any feedback and resources regarding this.** Thanks!!
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Wiki exploratory laparotomy-trauma's
- Thread starter cburns
- Start date
LeslieJ
Networker
exploratory laparotomy-trauma
All surgical cases include exploratory procedures - how else would the surgeon know what to do? This is especially so in cases of trauma.
If you want to prove this, to to the CCI Edits on the CMS website and instead of just looking at the edits, go to the Overview page (upper left hand corner is a link - Overview). Click on the NCCI Policy Manual for Part B Carriers.
When you open this up, you'll see a bunch of PDFs with different chapters. Unfortunately, the chapter number doesn't correspond to the CPT chapters (numeric sections). You can locate the chapter that has CPT 49000 by clicking on the pdf titled: TOC (table of contents).
Once you get your chapter, start reading - very interesting stuff can be found by reading the NCCI Manual. I don't read it often enough, but what you want & the rationale will be found right there.
Leslie J
http://www.askleslie.net
All surgical cases include exploratory procedures - how else would the surgeon know what to do? This is especially so in cases of trauma.
If you want to prove this, to to the CCI Edits on the CMS website and instead of just looking at the edits, go to the Overview page (upper left hand corner is a link - Overview). Click on the NCCI Policy Manual for Part B Carriers.
When you open this up, you'll see a bunch of PDFs with different chapters. Unfortunately, the chapter number doesn't correspond to the CPT chapters (numeric sections). You can locate the chapter that has CPT 49000 by clicking on the pdf titled: TOC (table of contents).
Once you get your chapter, start reading - very interesting stuff can be found by reading the NCCI Manual. I don't read it often enough, but what you want & the rationale will be found right there.
Leslie J
http://www.askleslie.net
codegirl0422
Expert
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I agree with LeslieJ. I have attached the exact link to CCI Edits on CMS in case you needed it. I have it saved in my favorites.
http://www.cms.hhs.gov/NationalCorrectCodInitEd/
http://www.cms.hhs.gov/NationalCorrectCodInitEd/