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General Surgery- billing seroma

  1. #1
    Default General Surgery- billing seroma
    Medical Coding Books
    I have recieved denials for Medicare for billing post op seroma ICD-9 for a FNA following a hernia repair. I billed the CPT with a -78. Since we are returning to the OR i thought we could get paid for these. Can anyone help with billing for post op seromas? Can we get paid or do we have to take a write off?

    Thank you!
    Ali Wenger, CPC

  2. #2
    Location
    Columbia, MO
    Posts
    12,531
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    what was your dx code and what did the denial state?

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default
    There were two claims. Both with CPT 10021-78
    the icd-9 on one was 998.51 and the other was 998.13

    CO-4: The Denial read: The procedure code is inconsistent with the modifier used or a required modifier is missing.

    Thank you!
    Ali Wenger, CPC

  4. #4
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by AWenger View Post
    There were two claims. Both with CPT 10021-78
    the icd-9 on one was 998.51 and the other was 998.13

    CO-4: The Denial read: The procedure code is inconsistent with the modifier used or a required modifier is missing.

    Thank you!
    Using modifier 78 implies the procedure was performed during the global period of the initial surgical procedure, the rejection implies the payor may not recognize the global period. Verify that the post op seroma aspiration was during the global, if so, appeal with documentation.

    HTH
    Danny L. Peoples
    CIRCC,CPC

  5. #5
    Location
    Columbia, MO
    Posts
    12,531
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    First to use 998.51 you need to add a code for the infective organism. Second it is possible they are wanting you to use the 79 modifier instead. While you and I see it as related, others say that because the original incision was undisturbed it is unrelated. Also the second time the patient had to return for the seroma I would lean toward the 58 modifier as a planned procedure. Just a thought.
    Last edited by mitchellde; 02-16-2011 at 10:09 AM.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Default
    ok. The claims were acutally for two different patients. I might do the-79. Thanks!
    Ali Wenger, CPC

  7. #7
    Location
    Fort Worth Texas
    Posts
    100
    Default
    Can you bill for a seroma aspiration done in the office during the global time period (10140 or 10160)?

    Thanks

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