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Billing for repair of surg access site requiring reconstruction

  1. #1
    Default Billing for repair of surg access site requiring reconstruction
    Medical Coding Books
    Hi, all,

    Patient had orbital fracture, doctor had to access the fracture via the canthus. Doc billed for fracture repair and Canthoplasty.

    I felt funny about billing for the canthoplasty, since there was no injury to the canthus; it was just used as access for repair, so I discussed it with the doc. He feels the canthoplasty billing is appropriate.

    He said that:
    -in this particular patient's case it was necessary to access the fracture via the canthus
    -more than simple closure was required, he actually had to reconstruct the canthus in order to finish the repair
    -in situations like these he does not always have to do a Canthoplasty (or access in this way), but in this patient's case it was necessary
    He asked that I bill the canthoplasty in addition to the orbital fracture repair.

    Perhaps this is akin to excision of lesions where, if more than simple closure is needed, a physician is instructed in CPT to bill the intermediate or complex repair codes in addition to the lesion removal?

    What are your thoughts? Has anyone encountered this situation? Not bundled. . .and as always, written references supporting your thinking are appreciated, if you know of any.


    Diane Mcvinney, CPC, OCS
    Billing Manager, Jones Eye Institute
    University of AR for Medical Sciences

  2. #2
    Milwaukee WI
    Default Incidental
    For an accurate response to a surgical coding question, please post the scrubbed operative note.

    It's hard to say for certain because I haven't seen the operative note.

    However, in general, I would consider this akin to the situation a general surgeon encounters when performing a laparoscopic procedure and finding an umbilical hernia at the port site. He doesn't USUALLY repair a hernia when he's doing a lap appy (for example), so this requires a little more work, but since it's the same incision used to the primary procedure, the umbilical hernia repair is considered incidental and is not coded.

    I would consider the repair he performed as incidental to the orbital fracture repair. It may have requried a bit more work than he usually performs, but I don't consider it a separately codeable procedure.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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