Ensuring right billing for surgical procedures


During a surgery, it is advisable and necessary to focus on the right kind of billing for different surgeries; this helps you in getting the rewards for your work done, and also improves your credibility and dependability as a surgeon.

For instance, there are some procedures that are not included in the excision of tumor codes. One of those is the neuroplasty of the nerve. If the tumor has nerve involvement or vessel involvement and you need to either remove that from that vessel or nerve, that can be billed separately. If you are removing parts of bone and you need to do some kind of repair reconstructions or grafting, that is also not included in these codes and is separately billable. You will get to know more about the orthopaedic surgeries in the recent orthopedic conferences 2013.

A new concept in the coding for 2010 has been introduced here in the musculoskeletal section.
There are codes in the digestive system and the urinary system that involved this new concept in coding, which is called re-sequencing. It's designated by a little number sign in front of the procedure code. If you concentrate on the soft tissue, the subcutaneous tumors, the differentiation in the codes is 3cm where the next group of codes are the subfascial or intramuscular tumors are at a different length, 5cm versus 3cm. So there is a change in the measurements depending on the code description. So you need to be aware of that and make sure that you are using the appropriate code as well as the appropriate size.

Orthopaedic surgeons have the same opinion on how knee arthroscopy should be coded. They all talk about the fact that procedures performed in different compartments are all separately billable. The way to designate a separate compartment or the procedures being performed in the separate compartment is the use of modifier -59.
Talking about the authorities in orthopedics, CMS, the AMA and the American Academy of Orthopedic Surgery or AAOS is taken into consideration. As they all have the same opinion on coding the knee arthroscopies.

There are three compartments of the knee. There are the lateral compartment, the medial compartment and the patellofemoral compartment. Every procedure that is performed in a different compartment is billed for a separate procedure. And then those subsequent procedures are designated with modifier -59.
The code should be reported only one time, regardless of how many areas are shaved. So, if we normally look into an operative report for a knee scope, it is the physician who makes the portals. They then go into those portals and do a diagnostic arthroscopy where they go from compartment to compartment, look at each area, determine what needs to be done in that area. And then once they've looked at all three compartments, they go back and perform the procedures.
Many times, there is a lot of frayed cartilage and what not in the different compartments. So basically, what CPT Assistant is saying is 29877 can only be billed once per operative session. So, we need to be careful that even if we're doing it in two separate compartments, we can only bill it once. So we'll never have 29877 billed for twice unless we're doing it in both knees, then we could have it. But you normally would not bill it in separate compartments.

Get the recent advancements on trends in medical coding and billing at AudioEducator.com.

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