Wiki Looking for guidance on co-worker matter

[raffertyelaine]

I am a recently certified COC.
I code/bill implant cases for multiple surgery centers.
We have an overseas coding team that takes care of the non-implant cases.
Today, I received an email from someone who is not a coder and she is asking me and the overseas team to do the following:

• Synovectomies always bill as total unless the op report says specifically partial was done
• Cpt 20610 can be billed for each injection given
• Debridements always bill extensive unless the op report says specifically partial was performed


These are very generalized statements to make, in my opinion.
I'd apreciate anyone's "take" on this!
I have been here over 2 years and this same person is always trying to add codes when I don't think they are there.

 

[jfolz]

Same boat here sometimes, directed to do things by people that aren't coders

I agree that 20610/20611 can be billed once for each MAJOR joint injected (Major joints being the shoulder, hip, knee joint, or subacromial bursa, as defined by CPT.) I did find this though, a CPT Assistant that is stating that you cannot bill an injection to a joint when another intra-articular procedure is also being performed. (See below. Not sure it applies to your exact situation but it might be helpful.) 20600/20604 are for small joints (fingers or toes) and 20605/20606 are for intermediate joints (wrist, elbow, ankle, olecranon bursa, temporomandibular, or acromioclavicular area)
Analgesia for postop pain administered into knee joint during scope
CPT Assistant, December 2007 Page: 10 Category: Bonus Issue
Surgery: Musculoskeletal System
Question:
If a surgical arthroscopy of the knee is performed (29870-29889) and after withdrawal of the scope and portal suture the surgeon injects bupivacaine for postoperative pain management directly into the knee joint, may code 20610 be reported in addition to the CPT code for the specific arthroscopic procedure performed?
Answer :
Code 20610, Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa), should not be reported when performed concurrent with another intra-articular procedure (eg, knee arthroscopy). However, should the bupivacaine injection be performed at an anatomic site other than that of the knee arthroscopy, then the appropriate code from the 20600-20610 series should be reported, as appropriate, with modifier 59, Distinct procedural service, appended.

The synovectomy and debridement statements are much too broad for me to speak on... I have been coding joints for several years and there are separate instructions for different joints and approaches (arthroscopic vs open) regarding what does and does not constitute complete or limited synovectomies and debridement. For instance...total arthroscopic ankle synovectomy codes to unlisted...would they prefer unlisted codes?
Personally, if the dictation is not clear enough to pinpoint total or partial and a query to the provider isn't possible, I always default to partial to avoid over-coding.
You can offer to provide the person asking you to do this the CPT guidelines... but I bet they won't appreciate it.

 

[Evelyn Kim]

I am a recently certified COC.
I code/bill implant cases for multiple surgery centers.
We have an overseas coding team that takes care of the non-implant cases.
Today, I received an email from someone who is not a coder and she is asking me and the overseas team to do the following:

• Synovectomies always bill as total unless the op report says specifically partial was done
• Cpt 20610 can be billed for each injection given
• Debridements always bill extensive unless the op report says specifically partial was performed


These are very generalized statements to make, in my opinion.
I'd apreciate anyone's "take" on this!
I have been here over 2 years and this same person is always trying to add codes when I don't think they are there.

I would be very concerned about coding directions being given by a non-coder. You are right the statements are too vague to be of use, remember the coder adage--If it is not documented it was not done. Of course if the person is someone who is a supervisor over you that might be an issue, but in general this type of direction, that goes against coding guidelines, is best to simply say "I will take it into consideration" and then follow the guidelines.

 

[raffertyelaine]

Thank you!