moeslilmom
Guest
I have a few questions regarding assignment of diagnosis codes when billing for a physician performing outpatient surgery.
Example 1: Multiple surgical procedures, different anatomic sites
Patient is having an ORIF of a left, displaced lateral malleolus fracture and an ORIF of an extra-articular, right distal radius fracture. When billing for these I have the following:
CPT 25607, pDX S52.501A-distal radius fx
CPT 27792, pDX S82.62XA-lateral malleolus fx
So when attaching the diagnosis, I would obviously attach the primary diagnosis for each as the first dx, but would I still attach the other diagnosis as the secondary on each, even though each injury is in a completely different anatomic site? (25607 w/ S52.501A, S82.62XA and 27792 w/ S82.62XA, S52.501A)
Example 2: Multiple surgical procedures, same anatomic site
My question for this example is pretty much the same, but when surgery is done in the same anatomical site but for different reasons (diagnosis), do you still use the primary reason and the primary diagnosis and then list the other conditions as the second, third, etc diagnosis?
Briefly, patient has lt shoulder rotator cuff tear, shoulder impingement, biceps tenosynovitis, and AC joint arthritis. Physician performs arthroscopic rotator cuff repair for rotator cuff tear, an open biceps tenodesis for biceps tenosynovitis, an arthroscopic distal clavicle excision for the AC joint arthritis, and an arthroscopic subacromial decompression for the shoulder impingement.
29827 w/ M75.122-rotator cuff
23430 w/ M75.22-biceps tenodesis
29824 w/ M19.012-clavicle excision
29826 w/ M75.42-decompression
For both examples, I am just asking about how to attach diagnosis. I do not need confirmation on whether the CPT codes and DX codes are coded correctly, bundled, etc. and I will attach modifiers once billed. I just need to know if I only attach the diagnosis related to the surgical procedure or if I would still attach each diagnosis to each procedure, only taking care to attach the reason for the procedure as the primary?
Thanks!
Example 1: Multiple surgical procedures, different anatomic sites
Patient is having an ORIF of a left, displaced lateral malleolus fracture and an ORIF of an extra-articular, right distal radius fracture. When billing for these I have the following:
CPT 25607, pDX S52.501A-distal radius fx
CPT 27792, pDX S82.62XA-lateral malleolus fx
So when attaching the diagnosis, I would obviously attach the primary diagnosis for each as the first dx, but would I still attach the other diagnosis as the secondary on each, even though each injury is in a completely different anatomic site? (25607 w/ S52.501A, S82.62XA and 27792 w/ S82.62XA, S52.501A)
Example 2: Multiple surgical procedures, same anatomic site
My question for this example is pretty much the same, but when surgery is done in the same anatomical site but for different reasons (diagnosis), do you still use the primary reason and the primary diagnosis and then list the other conditions as the second, third, etc diagnosis?
Briefly, patient has lt shoulder rotator cuff tear, shoulder impingement, biceps tenosynovitis, and AC joint arthritis. Physician performs arthroscopic rotator cuff repair for rotator cuff tear, an open biceps tenodesis for biceps tenosynovitis, an arthroscopic distal clavicle excision for the AC joint arthritis, and an arthroscopic subacromial decompression for the shoulder impingement.
29827 w/ M75.122-rotator cuff
23430 w/ M75.22-biceps tenodesis
29824 w/ M19.012-clavicle excision
29826 w/ M75.42-decompression
For both examples, I am just asking about how to attach diagnosis. I do not need confirmation on whether the CPT codes and DX codes are coded correctly, bundled, etc. and I will attach modifiers once billed. I just need to know if I only attach the diagnosis related to the surgical procedure or if I would still attach each diagnosis to each procedure, only taking care to attach the reason for the procedure as the primary?
Thanks!