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Metatarsal Head Resection VS. Amputation

Can someone take a look at this report? The doctor picked an amputation code for this procedure, then states he only excised the metatarsal head. Thanks!

Following satisfactory placement of the patient supine on the operating table satisfactory timeout was accomplished, satisfactory general anesthesia was induced by Dr. taken, and sterile prep and drape of the left lower extremity was accomplished. The left first metatarsal head had osteomyelitis and an underlying plantar ulcer. As such a 3-1/2 cm longitudinal incision was made with a 15 blade overlying the metatarsal head and distal shaft of the metatarsal. The incision was carried down through the subcutaneous tissues down onto the metatarsal shaft and carried through to the metatarsal head. Dissection proceeded to free up the metatarsal and then a micro-oscillating saw was used to transect the metatarsal shaft at the distal third. Once transected the metatarsal shaft was grasped with a towel clip was a brittle bone and it splintered. But with a grasping elevation was accomplished away from the underlying soft tissues in the plantar surface along with tenderness insertions and these were debrided and excised the sesamoid bone was also identified and excised. The metatarsal head was separated from the proximal great toe at the joint space. The proximal area of the first metatarsal shaft was sent for culture and the metatarsal head was sent for culture and pathologic examination. The sesamoid bone was also sent for culture and for pathologic examination. Following this the surgical bed was irrigated with saline and then closed with 3-0 Monocryl for the subcutaneous tissue after satisfactory hemostasis and the skin was closed with interrupted 4-0 Prolene sutures. Sterile dressing Kling and Ace wrap was applied. Patient tolerated procedure well was taken to recovery room in stable condition.

Medical Billing and Coding Forum

Can you “repair” the peroneal tendons by repairing the “retinaculum” ?

Patient had an ankle injury and the retinaculum over the peroneal brevis and longus was torn. The physician repaired the retinaculum which holds these down. However, the physician wants to bill for repair of dislocating tendon (27675) but in addition wants to bill for repairing the tendons themselves (27659) which I don’t understand. He never did anything to repair the actual tendons, only repaired the retinaculum so they could stay in place. Would you allow an actual tendon repair for this?

If you are really good with ankle surgeries please don’t hesitate to contact me with questions.

Thank you!

Medical Billing and Coding Forum

Clarification is needed Plz

Hi,
I’m confused with the wording on the CMS
doc below . Can someone please explain with a few examples on how to code and modify the charges for Medicare patients -especially sedation
99152/99153
https://www.cms.gov/Regulations-and-…ds/R3763CP.pdf

One more question,
If patients underwent an incomplete G0105-53
and returning within 12 month to complete the screening
In view of the coding regulations and all charges integrity, should the second visit be coded to G0105 or to 45378?

Thank you,
Booz, COC

Medical Billing and Coding Forum

Do we need to code venogram separately?

ULTRASOUND GUIDANCE FOR VENOUS ACCESS

SUPERIOR VENA CAVAGRAM

TUNNELLED CVC INSERTION

DESCRIPTION OF PROCEDURE:

Realtime ultrasonography of the right neck was performend demonstrating
patency of the internal jugular vein which was then chosen for access;
ultrasound images were archived.

A large area of the right neck and upper chest was prepped and draped in
sterile fashion.

Using 1% lidocaine for local anesthesia and under real-time ultrasonic
guidance, a 21ga. micropuncture set was used to access the right internal
jugular vein at the base of the neck. Ultrasound images were archived.

A small incision was made at the puncture site. The wire could not be
advanced much into the vessel and for this reason a 4 French catheter was
advanced over the wire. Contrast material was injected and digital
angiograms were obtained demonstrating occlusion of the superior vena cava
just beyond the confluence of the azygos vein. Flow in the azygos vein is
retrograde.

Over a wire, the tract was dilated and an introducer sheath was advanced into
the vein.

A tract of subcutaneous tissue, leading from the incision at the puncture
site to the anterior right chest below the clavicle, was then infiltrated
with local anesthetic. A small incision was made at the chest end of the
tract. A flexible tunneler was then used to pull an 8 cm long dual-lumen
catheter through the subcutaneous tunnel. The tunneler was disconnected and
the catheter was then advanced through the sheath until its tip reached the
central portion of the patent superior vena cava ; as mentioned above the
catheter could not advance be advanced into the right atrium since the cava
is occluded more centrally.

Fluoroscopy of the air at demonstrated a kink in the catheter as it entered
the internal jugular vein. We were unable to resolve the kink and for this
reason the catheter had to be removed and the procedure restarted after re-
prepping and draping of the area.

Using sterile technique under real-time ultrasonic guidance a 21 gauge needle
was placed in the right internal jugular vein. An introducer sheath was
advanced into the vein.

A 6 French dual-lumen central venous catheter was then advanced through the
subcutaneous tunnel and into the internal jugular vein until its tip reached
the central portion of the patent superior vena cava. This time no kinks
were identified along the course of the catheter.

Both ports were capped and heparinized and the catheter was then secured to
the skin with 2-0 nylon sutures. The incision at the base of the neck was
closed with tissue glue and SteriStrips.

There were no complications.

CAN ANYBODY SUGGEST CORRECT CODING FOR THIS?

Medical Billing and Coding Forum

Codding Mohs for first time

Hello,

I am learning a new field and I want to make sure I am billing this correct…
OP NOTE: Mohs left shin

Chemosurgery (Mohs Technique), second stage, fixed or fresh tissue, up to 5 specimens and first stage, fresh tissue technique, up to 5 specimens. patient was brought to operating room and place on the table in a supine position. a biopsy report of the operative site was reviewed and lesion’s location confirmed by the patient. the lesion was removed by Mohs’ surgery, fresh-tissue technique in 2 stages with 4 frozen sections of tissue processed. 4 frozen sections of tissue were stained and examined with hematoxylin and eosin stain. all tissue which was removed from the lesion site was examined by frozen section technique with detailed mapping of the tissue, and with the doctor reading the slides.
A layer:2/2+
B layer: 2/2-

So I am reading it as follow with CPT CODES 17313 and 17314×2????
Any help would be really appreciated, I would like the doctor to receive full payment that he deserves.

Medical Billing and Coding Forum