I'm not an ortho specilist ... but
I think the hospital is on the right track with 10121, but that seems a little weak given the amont of work done here. He comments on the difficulty delineating the subcutaneous tissues from the patellar tendon., which certainly qualifies for "complicated." On the other hand there were multiple sutures that needed to be removed.
I think the surgeon's code for 27301 is close but no cigar as well. There is no documentation of an abscess. He even titles his report "scar revision and exploration" He would have to amend his op note to clarify.
Complex repair - 13120 to 13122 - may be the best option, although he doesn't mention the length of the wound, and you'd need that to correctly code it. Again, he'd have to amend his op note to clarify.
11406 for the lesion removal (i.e. a simple scar revision) was completely wrong for a pre-auth ... but perhaps his office staff didn't know about the deep infection when they sought the pre-auth.
12020 is also incorrect because it is for a simply closure of a wound dehiscence ... the surgeon cleans the open edges and sutures it. This was MUCH more work.
Hope that helps.
F Tessa Bartels, CPC, CEMC
- ICD-10 Trainings
- Comprehensive Courses
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join