Know the Types of Graft

Question: What’s the difference between a spinal allograft and an autograft?
Answer: If the surgeon harvests bone from the patient’s own body, you’ll code for an autograft with one of the following codes:
+20936 — Autograft for spine surger…

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52300 or No 52300 For Ureterocele?

Question: My urologist performed a cystoscopy, transurethral incision of an orthotopic ureterocele, ureteroscopy, and a double J stent placement. I have drawn a blank on how to report the ureterocele incision. Here is the doctor’s note: “A 24 resec…

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OIG Hit List: Perfect Your 38220, 38221, and G0364 Usage

Don’t sweat reporting 38220-59 if you meet these Medicare-approved conditions.
If your oncologist takes both a bone marrow biopsy and a bone marrow aspiration, whether you’ll see Medicare reimbursement depends on the two guidelines below. But watch out: With OIG scrutiny and a HCPCS twist, these guidelines will put your coding savvy to the test.
Append 59 […]

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Use This Podiatry Scenario to Perfect Your Emerging Technology Claims

Hint: If you try to use an unlisted code, be sure your OP notes include this information.
If you don’t know the ins-and-outs of coding cutting edge procedures, you risk getting left in the dust as medicine continues to evolve. A new techniques, however, doesn’t always mean a new, corresponding CPT code. Check out this podiatry […]

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Factor Location and Depth into Foreign-Body Removals

Explore these three “what if” scenarios to perfect your FBR claims.
Your foreign-body removal (FBR) coding can vary greatly depending on the type of foreign body, its anatomic location, and the depth from which the physician must remove it. Here are three case studies to help you find your way.
Case 1: No Incision Means No Separate […]

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Surgery Coding Challenge: Master Microsurgery Units With This Advice

Check your EOB to make sure payers don’t apply a multiple-procedure reduction to +69990.
Question: When my ENT uses a microscope during a procedure, what guidelines can I use for choosing between 92504 and +69990? Is there a rule governing how many times you can report the add-on code 69990?
Answer…
You can use 92504 (Binocular microscopy [separate […]

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Cataract Surgery Coding Skill Builder

Determine ‘planned or unplanned’ before separately coding vitrectomy.
With several possible surgical treatments for cataract procedures, which you probably code more often than any other surgery, there’s a lot of room for error – with over $890 at stake for complex cataract procedures in 2009.
Use these tricky scenarios as a guide through some of the most […]

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Skull Biopsy, No Burr Hole: 61500 or 61563?

Question: Our surgeon biopsied a lesion from the skull, but did not perform a craniectomy or create a burr hole for the procedure; he made an incision over the lesion and obtained the biopsy. How should I code this?
Answer: Your best option is 61500 (Craniectomy; with excision of tumor or other bone lesion of skull) […]

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52214 Coding Challenge: Fulguration, Then TUIBNC

Question: If my physician went to do a TUIBNC and found bleeding of prostatic varices, fulgurated them, then did the TUIBNC, can I charge the 52214 for the fulguration of the prostatic varices?
Answer: Yes. You can report both the transurethral incision of the bladder neck contracture (TUIBNC) and the fulguration of the bleeding varices your […]

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