Cyst Expression: I&D or Excision?

Question: Documentation reads, “The cyst was excised after performing a central incision directly on the cyst. All the material was expressed, then cyst capsule was removed completely and excised completely. Packing was performed.” Should I code the procedure as an I&D or an excision?

Supercoder.com/forum/

Answer: You should look at the pathology report and any further excision description to reach the correct code set. “Excision is defined as full thickness [through the dermis] removal of a lesion …,” according to CPT’s Excision-Benign Lesions guidelines. The documentation you provided does not indicate what tissue levels the excision involved. A cyst can be epidermal or sebaceous (706.2). A lesion that is removed from the epidermis (top skin layer) does not meet CPT’s excision definition.

The sebaceous gland extends through the dermis. Excision that deep would qualify for an excision code. An excision code (such as 11400, Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 0.5 cm or less) requires further documentation detailing the lesion’s morphology, size (including margins), and anatomical location. Without this information, the I&D code (10060, Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; simple or single) may be more appropriate. The physician made a cut to drain the cyst and then drained (expressed) all the material. The cyst capsule removal is part of the treatment of the I&D to prevent the blockage from reoccurring.

Take more coding challenges with Family Practice Coding Alert. Written by Jen Godreau, BA, CPC, CPEDC, content director of Supercoder.com, Family Practice Coding Alert, Volume 12, Number 6.

Read More »

Heads Up Coders: 2013 ICD-10 Implementation Date Is Firm

Plus: CMS has proposed freezing the ICD-9 codeset after next year.

If you were hoping that the Oct. 1, 2013 ICD-10 implementation date wasn’t set in stone, you are out of luck. That’s the word from CMS during a June 15 CMS Open Door Forum entitled “ICD-10 Implementation in a 5010 Environment.”

“There will be no delays on this implementation period, and no grace period,” said Pat Brooks, RHIA, with CMS’s Hospital and Ambulatory Policy Group, during the call. “A number of you have contacted us about rumors you’ve heard about postponement of that date or changes to that date, but I can assure you that that is a firm implementation date,” she stressed.

Brooks indicated that the rumor about a potential delay in the implementation date continues to persist throughout the physician community, and recommended that practice managers alert their physicians to the fact that that the rumor is untrue.

The Oct. 1, 2013 date will be in effect for both inpatient and outpatient services. Keep in mind that the ICD-10 implementation will have no impact on CPT and HCPCS coding, Brooks said. You will still continue to bill your CPT and HCPCS procedure codes as before.

You’ll Find Nearly 55,000 Additional Codes

Currently, CMS publishes about 14,000 ICD-9 codes, but there are over 69,000 ICD-10 codes. The additional codes will allow you to provide greater detail in describing diagnoses and procedures, Brooks said.

If you’re wondering which specific codes ICD-10 includes for your specialty, you can check out the entire 2010 ICD-10 codeset, which CMS has posted on its Web site. “Later this year, we’ll be posting the 2011 update,” Brooks said during the call.

@ For more details on CMS’ upcoming plans, subscribe to Part B Insider (Editor: Torrey Kim, CPC).

Sign…

Read More »

Wound Coding: 3 Tips Help You Recover Your Full Debridement Pay

Maximize 11040-11044 pay with modifier 51.

In most cases, your practice won’t report debridement separate from wound repair codes. But when exceptions arise, follow these three tips to choose the appropriate wound repair code.

If you’re considering reporting debridement separate from a wound closure, make sure your physician’s notes clearly document that the wound was contaminated and required saline or other substances or instrumentation to cleanse and debride the wound.

Don’t miss: If you report a debridement code with your wound closure codes, append modifier 59 (Distinct procedural service) to the debridement code. This informs the payer that you recognize that debridement is generally bundled into wound repair, but that clinical circumstances required the physician to perform debridement as a separate service.

1. Look for Wound Repair With the Debridement

CPT specifies that you may also report debridement codes independently of repair codes when the physician removes large amounts of devitalized or contaminated tissue or when the physician performs debridement without immediate primary repair of a wound, notes Pamela Biffle, CPC, CPC-I, CCS-P, CHCC, CHCO, owner of PB Healthcare Consulting and Education Inc. in Watauga, Texas.

The physician may clean debris from the wound without repairing the wound because it was either not deep enough to require repair or the physician delayed the repair due to an extenuating circumstance.

In the case in which the dermatologist excises a lesion, debridement is included in the procedure. However, when the dermatologist only performs debridement or performs the debridement in addition to the wound repair, such as the case when a wound is excessively dirty or contaminated with debris, you would also code the debridement code with the wound repair/excision code, appending modifier 51 (Multiple procedures) for the multiple procedure.

Example: A patient returns to the dermatologist several days after a chemical…

Read More »

Give Your Radiosurgery or Gamma Knife Surgery Coding a Check-Up

Improve your reimbursement chances by applying modifier 58 in this situation.
When your surgeon targets the brain or spine with stereotactic radiosurgery (also called gamma knife surgery) to treat multiple lesions over multiple sessions, you need to know two crucial things: what stereotactic radiosurgery codes to use and how many units to include.
Take this three-question challenge […]

Related articles:

  1. Take Our Multi-Level Spinal Surgery Coding Challenge AUDIO TRAINING EVENT: Receive Optimum Reimbursement for Spinal Co-Surgeries,…
  2. Check Destruction Method Before Assuming 17110You could gain $30 if a shave is also performed….
  3. Second Surgery Coding: Tips for Modifier 58, 78 SuccessDon’t let ‘unplanned’ lead to ‘unpaid.’ The next time a…
Read More »

Oncology Coding: Day 1 of FOLFOX4 Regimen

Here’s the key to concurrent infusion coding.
Question: What are the appropriate codes for the first day of the FOLFOX4 regimen?
Answer: You should base your final coding decision on the documentation and the exact services your practice provides. But as a starting point, the FOLFOX4 regimen typically involves the patient receiving Oxaliplatin and folinic acid concurrently […]

Related articles:

  1. Oncology Coding Challenge: When Infusion Runs Long Question: The oncologist ordered a 90-minute chemotherapy infusion service,…
  2. Infusion Coding Education: Remicade Coding Hint: Watch for ‘add-ons’ during Remicade sessions Question:…
  3. Do I Use a Chemo Code for Zevalin Therapy?Question: When I looked up Zevalin, I found out it’s…
Read More »

Critical Care Coding FAQ: Become a Master of Time

Beware: CPT, CMS differ on ‘family discussion’ parameters.
When the physician treats a patient with a critical illness or injury, you need to know when to start and stop the critical care clock in order to avoid miscoding. Check out this FAQ to find out what’s part of critical care, what’s not, and how to correctly […]

Related articles:

  1. Maximize 99291 Coding with This Critical Care FAQ Physician ‘preventing further deterioration’ keys valid critical care claims….
  2. Critical Care Coding Checklist Certain patient conditions could indicate 99291 service. Given the…
  3. Bust 4 Myths About Pediatric Critical Care Services MYTHBUSTER: Codes 99291, +99292 apply to infants, young pediatric…
Read More »

PQRI 2010: Tips That Boost Your Practice’s Revenue

Follow our links and advice to put more plusses in your claims column
Back again for 2010 is Medicare’s incentive-driven physician quality reporting initiative (PQRI), aimed at tracking quality metric or patient care services that physicians provide. When the practice treats enough patients in the same category, some PQRI dollars might be only a few codes […]

Related articles:

  1. Smokin’ PQRI Pointers We’ve got the G codes you need to score…
  2. PQRI: No Coumadin Due to Fall RiskPlus, experts at the AMA meeting in Chicago tell you…
  3. Accurate Diabetes ICD-9 Coding = PQRI BonusInternal medicine providers interested in a year-end bonus from Medicare…
Read More »
Share on facebook
Share on twitter
Share on linkedin
Share on whatsapp

Most Popular: