Coding a Hand Assisted Laparoscopy

Question:

The surgeon described the procedure as a ‘hand assisted laparoscopy”. He brought part of the bowel outside of the body for evaluation. Does this convert the procedure to open?

Answer:

Mobilizing the bowel outside the body (extracorporeally) during a laparoscopic procedure does not convert the procedure to open, it is still considered a laparoscopic procedure and coded as laparoscopic.

*This response is based on the best information available as of 04/21/22.

2021 EM Guidelines: Only for Medicare?

Question:

I work with a surgeon and we see just a few Medicare patients. The surgeon believes the revised 2021 E/M guidelines will not impact our office practice because of our low Medicare volume.

Is this correct?

Answer:

This is not correct and is a common misconception. The revised documentation requirements come from the American Medical Association (AMA) for CPT™. These are the folks that write the codes, not a specific payor.

The changes were essentially agreed to by the Center for Medicare and Medicaid Services (CMS), but they are changes to the code descriptors and guidelines in CPT. One of the primary goals of the change, other than simplification, is standardization. We know that commercial payors and CMS have a variety of documentation standards to support a level of E/M service. Beginning in January 1, 2021, CPT™ has standardized the documentation of the specific level of new and established outpatient visit, which should be applicable to all commercial and government payors.

*This response is based on the best information available as of 04/7/22.

Hartmann or Partial Colectomy

Question:

My surgeon performed all the components of a Hartmann procedure 44143 but did not create a colostomy. Can we use 44143 with a -52 modifier?

Answer:

The correct code for this procedure would be 44140.  Code 44140 is the base code for 44143 with the only difference being a skin level colostomy, so it would be inappropriate to code 44143-52 as there is an established code already in place.

*This response is based on the best information available as of 03/24/22.

Billing for a Wound Vac

Question:

Can you bill for a wound vac on a surgical incision if the patient has a history of incision infections to help prevent this?

Answer:

The AMA published clarification on wound vac billing in the October 2021 CPT Assistant. Negative pressure wound therapy (97605-97606) is considered billable for both open and closed wounds. However, that does not mean that payors will reimburse separately for the service, so use caution and track results.

*This response is based on the best information available as of 03/10/22.

Using Modifier -22 for Adhesiolysis

Question:

My provider indicated that it took her an additional 80 minutes during a surgery to perform adhesiolysis. Is documentation of the time sufficient?

Answer:

Although time (specific minutes) should always be indicated in the operative note, the provider must also give the reasonwhythe lysis took longer (what complicated this part of the surgery). For example, the patient’s BMI was 42 or history of 10 previous abdominal surgeries. This is true any time modifier -22 is used for any procedure, not just for lysing adhesions.

*This response is based on the best information available as of 02/24/22.

Billing E/M Visits During the Global Period

Question:

Can I bill different diagnosis codes for conditions/problems when seeing a patient in the hospital after surgery, but during the stay of a major surgery?

Answer:

It depends. You cannot bill for related issues or known complications that arise from the surgery, but you can bill for unrelated conditions/problems with proper documentation that supports billing. It must be clear in the documentation that the condition is unrelated with a clear plan of treatment for the new/unrelated issue. You would need to add a modifier -24 to any unrelated E/M service performed.

*This response is based on the best information available as of 02/10/22.