Hello,
I want to make sure I am clear on how to bill/not bill for accidental lacerations during a procedure. I understand the CMS NCCI manual has instructions on iatrogenic incidents in certain chapters relating to specific procedures, but there isn't any guidance in the musculoskeletal chapter. I am curious if others would see the below as an iatrogenic injury and not separately billable as documented. (I have asked the provider to clarify the documentation on whether the nerve was found needing repair and wouldn't have been seen if the neurovascular bundle wasn't transected during the case versus the nerve was cut when the bundle was transected.) Can anyone direct me towards specific documentation/proof to support not billing for things like this. This provider is not going to be happy so I want to have support ready. Thank you in advance!
"The little finger was approached next. This was stuck down even more due to previous Xiaflex treatment. A thick ulnar cord was identified radially. Proximally, the neurovascular bundle was identified and traced distally. Distally the neurovascular bundle was identified and traced proximally. In the process of stretching the finger and identifying the nerves which were plastered to the skin there was a transection to the neurovascular bundle, and stretching the finger ended up showing a nerve gap. At this point a closed capsulotomy was not attempted for the little finger but some of the cord was removed to be able to give a little bit more opening of the finger. The nerve then had to be repaired. We were able to trim the nerve ends and put a conduit since the nerve gap on full stretch was about 1 cm. This was a 2 mm conduit by 1.5 cm conduit. The ulnar neurovascular bundle was intact."
I want to make sure I am clear on how to bill/not bill for accidental lacerations during a procedure. I understand the CMS NCCI manual has instructions on iatrogenic incidents in certain chapters relating to specific procedures, but there isn't any guidance in the musculoskeletal chapter. I am curious if others would see the below as an iatrogenic injury and not separately billable as documented. (I have asked the provider to clarify the documentation on whether the nerve was found needing repair and wouldn't have been seen if the neurovascular bundle wasn't transected during the case versus the nerve was cut when the bundle was transected.) Can anyone direct me towards specific documentation/proof to support not billing for things like this. This provider is not going to be happy so I want to have support ready. Thank you in advance!
"The little finger was approached next. This was stuck down even more due to previous Xiaflex treatment. A thick ulnar cord was identified radially. Proximally, the neurovascular bundle was identified and traced distally. Distally the neurovascular bundle was identified and traced proximally. In the process of stretching the finger and identifying the nerves which were plastered to the skin there was a transection to the neurovascular bundle, and stretching the finger ended up showing a nerve gap. At this point a closed capsulotomy was not attempted for the little finger but some of the cord was removed to be able to give a little bit more opening of the finger. The nerve then had to be repaired. We were able to trim the nerve ends and put a conduit since the nerve gap on full stretch was about 1 cm. This was a 2 mm conduit by 1.5 cm conduit. The ulnar neurovascular bundle was intact."
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