jennburgel
Networker
I bill for an asc in nj, can we bill for g0168 and expect reimbursement? Has anyone used this code and received payment?
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki G0168 will it reimburse for asc's
- Thread starter jennburgel
- Start date
delphinus777
Networker
I think it all depends on the carrier you are billing it to.
Here is a "Tip" from Supercoder for G0168:
Medicare Stipulates G0168 for Tissue Adhesive
If the physician only uses liquid skin adhesive (Dermabond) to close a wound, you should report G0168
If the physician uses sutures or staples in combination with Dermabond for repair, you should report only the appropriate laceration repair code (12001-13160). You should not report G0168 with 12001-13160
Scenario 1:-
Question: A patient with a cut on her left forearm reports to the ED. Using Dermabond, the ED physician closes the 6.3-cm laceration. Can I code this with the laceration repair codes?
Answer: If the payer does not follow Medicare coding conventions, you'll most likely report a laceration repair code. In this case, 12002 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.6 cm to 7.5 cm) would be appropriate.
However, you should report G0168 (Wound closure utilizing tissue adhesive only) for the service for Medicare patients (and patients whose payers follow Medicare rules). Medicare calls for this code when Dermabond is the only closure material the physician uses on a simple injury.
Scenario 2:-
Question: I found a HCPCS code for Dermabond. Can I use G0168 instead of a CPT wound repair code?
Answer: No. The HCPCS G code (G0168, Wound closure utilizing tissue adhesive only) is for Medicare use only. For private payers, stick with the CPT simple repair code (12001-12018).
Although commercial carriers still recognize the existing CPT codes for simple laceration repair using Dermabond, Medicare restricts the CPT laceration repair codes to placement and removal of sutures and staples. Medicare created G0168 because it felt repairing a laceration with Dermabond was not comparable to sutures/staples placement and removal.
Scenario 3:-
Question: A 60-year-old patient reports to the ED with a bandaged left hand. The patient says she was cleaning out the blades of her snow blower and cut her left index finger; the wound is wrapped in gauze, but it is reddening with blood. During an expanded problem focused history and exam, the physician undresses the wound, applies pressure and ice to stop the bleeding, and cleans it using Betadine. During the E/M service, the physician notes a laceration to the index finger but no signs of infection. Using Dermabond, the physician closes a 2.7 cm laceration on the patient's finger. How should I code this encounter?
Answer: It depends on the insurer; Medicare has its own rules regarding single-layer laceration repairs in which Dermabond is the only closure material.
Here is a "Tip" from Supercoder for G0168:
Medicare Stipulates G0168 for Tissue Adhesive
If the physician only uses liquid skin adhesive (Dermabond) to close a wound, you should report G0168
If the physician uses sutures or staples in combination with Dermabond for repair, you should report only the appropriate laceration repair code (12001-13160). You should not report G0168 with 12001-13160
Scenario 1:-
Question: A patient with a cut on her left forearm reports to the ED. Using Dermabond, the ED physician closes the 6.3-cm laceration. Can I code this with the laceration repair codes?
Answer: If the payer does not follow Medicare coding conventions, you'll most likely report a laceration repair code. In this case, 12002 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.6 cm to 7.5 cm) would be appropriate.
However, you should report G0168 (Wound closure utilizing tissue adhesive
Scenario 2:-
Question: I found a HCPCS code for Dermabond. Can I use G0168 instead of a CPT wound repair code?
Answer: No. The HCPCS G code (G0168, Wound closure utilizing tissue adhesive
Although commercial carriers still recognize the existing CPT codes for simple laceration repair using Dermabond, Medicare restricts the CPT laceration repair codes to placement and removal of sutures and staples. Medicare created G0168 because it felt repairing a laceration with Dermabond was not comparable to sutures/staples placement and removal.
Scenario 3:-
Question: A 60-year-old patient reports to the ED with a bandaged left hand. The patient says she was cleaning out the blades of her snow blower and cut her left index finger; the wound is wrapped in gauze, but it is reddening with blood. During an expanded problem focused history and exam, the physician undresses the wound, applies pressure and ice to stop the bleeding, and cleans it using Betadine. During the E/M service, the physician notes a laceration to the index finger but no signs of infection. Using Dermabond, the physician closes a 2.7 cm laceration on the patient's finger. How should I code this encounter?
Answer: It depends on the insurer; Medicare has its own rules regarding single-layer laceration repairs in which Dermabond is the only closure material.