india ink
Our physician has also performed procedures & used the India Ink tattooing. The primary procedures performed were different: 44378, another pt 45385 & next pt 44360. On the 3rd pt. he also performed an UGI/43235 same encounter. (causing multiple procedure issue) Our biller/coder used 11920 for the India Ink, listing procedure code first. I disagreed. Two insurance carriers denied as non covered cosmetic procedure/pt responsibility, even after appeal(s). The third carrier paid a little over 105.00 for the procedure, with no pt responsibility.
I am inclined to want the tattooing billed using the correct procedure code w/a -59 modifier. During the procedure, a lesion, etc. is identified & the doctor marks the area/lesion, for the surgeon(s) to easily find & remove all of malignant area.
I have not found any documentation, &/or information to make an argument as how to code it differently. If anyone knows of how this is to be billed or where to find documentation, information or references of the billing for this type of procedure, it would be greatly appreciated!
I would not use 11920. This is intradermal. The submucosal injection is what I would use. Here is what CPT assistant says!
Sigmoidoscopy with submucosal injection(s)
CPT Assistant, March 2003 Page: 22 Category:
Related Information
Surgery / Digestive System
Question:
For codes 45335, Sigmoidoscopy, flexible; with directed submucosal injection(s), any substance, and 45381, Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal injection(s), any substance, would the injection of india ink qualify for the reporting of this code?
AMA Comment:
Yes. Prior to the addition of these codes in 2003, there were no codes in the CPT code set that adequately described the additional time, work involved, and risk to the patient of the submucosal injection, as typically, this is a more difficult and lengthy endoscopic procedure. The code descriptor for both codes is generic in stating "any substance" and is to be reported only once for each procedure regardless of the number of injections performed. Examples of a substance that may be injected includes India ink, which permits marking of a lesion allowing easier surgical or endoscopic identification of the involved segment of the gastrointestinal tract in the future. Other examples of submucosal injected substances are botulinum toxin, saline, and corticosteroid solutions.
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