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We have been billing 71100 – rib unilateral 2 views & 71046 – 2 views of the chest.
We have been receiving denials stating we should use 71101 – ribs unilateral 2 views with pa chest minimum of 3 views.
I thought 71101 was for only if we did 2 views of the rib and 1 view of the chest.
Is this correct and we should be using cpt code 71101 or did we list 71100 and 71046 with the 59 modifier on the chest xrays?
Thanks,
Jo
Please note: Patient had an excisional biopsy of the caudate lobe in addition to insertion of a left chest tube.
The following is the only documentation related to the insertion of the chest tube:
Under general anesthesia, the patent’s abdomen and left chest were prepped and draped. A #16 chest tube was inserted in the intercostal space using ultrasound guidance. 200 to 300 mL of turbid fluid were obtained and these were sent for culture and sensitivity, cell count, triglycerides, and cytology. The chest was then attached to a Pleur-Evac and a small amount of air was also seen to exit.
32550, 32551 or 32557
Also, AAPC indicates that tracheal placement can be included under Neck exam.
The patient had had an aggressive left breast cancer that required mastectomy and then later had a recurrence that required radiation therapy which progressed. She ultimately had to have a chest wall resection and to cover this an implant and a latissimus flap were used. This was in 2017. She has had a sinus tract for the past two to three weeks.
The medial portion and inferior portion of the latissimus flap were opened with the use of a #10 knife blade. Bleeding was controlled with electrocautery. At this point, copious amounts of purulent drainage were identified and this was cultured. The myocutaneous flap, this was a latissimus myocutaneous flap that had been fashioned by Dr. B several months ago, was actually fairly adherent to the Proceed mesh. Underneath this, there was an opening that had to be bridged with a prosthesis/implant several months ago. She had had a chest wall resection where we removed several ribs. The entire chest wall and lung were present and could be visualized. The prosthesis/implant was fashioned with methyl methacrylate and Proceed mesh as a sandwich type prosthesis. It was fashioned appropriately and originally affixed to the chest wall and ribs with wire.
The incision this time required dissecting the myocutaneous flap off of the mesh and the methyl methacrylate implant. This was peeled back and drainage was identified as well as granulation tissue. All wire sutures were removed, and in doing so we removed the entire implant, as I stated consistent with a sandwich of Proceed mesh and methyl methacrylate. At this point, using a curette and a rongeur, all granulation tissue and obviously infected tissue was debrided. We did not have to place a new implant because the pleura underneath the prosthesis had sealed, there was no evidence of a pneumothorax, and there was no exposure of the lung.
At this point, the task was to remove all infected tissue as well as all foreign bodies that had been impregnated in the surrounding tissue. This also required debridement of granulation tissue from underneath the flap. The flap remained quite viable. Again, after removing this we irrigated the defect with 3 liters of saline to which bacitracin was added.
I cannot find a code that addresses this adequately. Help please????
Thank you
Going crazy.:(
If you do single view multiple times during the same day are you charging single view with 59/76/77 modifiers or are you billing 71048 only?
Here is the OP note:
POST ADMISSION PHYSICAL EVALUATION:
Patient with the dizziness increased shortness of breath and a worsening chest x-ray with accumulation of pleural effusion on the right side question of placement of previous chest tube will reevaluate and change chest tubes.
PREPROCEDURE DIAGNOSES:
Hemothorax/pleural effusion
RATIONALE FOR PROCEDURE:
Accumulation of pleural fluid with shortness of breath and increase hypotension
PROCEDURE IN DETAIL:
Under L control and sterile conditions using aseptic technique and after obtaining informed consent from patient timeout was called and #24 French chest tube was prepped and the previous chest tube was withdrawn without any difficulties. Aiming to go above the rib between the fifth and fourth space blunt dissection with finger as well as with hemostats was done until obtaining good placement. Chest tube was introduced without difficulties obtaining a spontaneous drainage of the dark blood fluid for approximately 500 cc. Chest tube was placed on Pleur-evac with suction and a total of 1000 cc were drained. No bright red blood was observed. No evidence of air leak was found. Patient was kept on Pleur-evac with suction. Chest tube was sutured in place and dressed without difficulties patient tolerated well procedure chest x-ray was reviewed next of kin was notified as well.
POSTPROCEDURE CONDITION:
Patient with O2 saturation above 100% with the 4 L nasal cannula blood pressure heart rate stable patient alert and answering questions appropriately in no distress. Chest x-ray showed chest tube in good place.
Having trouble with 99284 vs 99285 decisions for discharged ED patients who present with chest pain. They’ve had a full workup (labs including troponin, CXR, EKG may be independently reviewed) and are sometimes treated with pain meds. It is difficult to tell if the CP is ‘compatible with symptoms of cardiac ischemia and/or pulmonary embolus’. The discharge diagnosis is generally chest pain. I am not sure if these patients are MDM moderate or high risk. What should I be looking for to support a level 5?
In the cases I am coding the patients are not admitted to IP or observation. I appreciate your thoughts. Thank you