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Although coding in this area may seem complex, you can simplify it with a quick review of requirements and carrier policies. Coding for spinal cord stimulation lead implantation is thought to be too complex and difficult for some. There are several reasons for this perception: There are coding differences based on the site of service […]
The post SPINAL Cord Stimulation Leads: A Coding Perspective appeared first on AAPC Knowledge Center.
Don’t Z codes usually deny if they are listed as primary dx?
Surgeon performed bilateral inguinal hernias and documented removal of part of cord lipoma on each side but only submitted a specimen for one side. Do I need pathology to code for bilateral? Should the right lipoma bundle since it was "incorporated" in the hernia? I was taught that if the surgeon didn’t sent a specimen to pathology we could not code it.
Thank you in advance.
49505-50
55520-59-50
** right side
** dissection of the cord structures and what appeared to be a cord lipoma incorporated within an indirect inguinal hernia
** further isolated the presumed cord lipoma
** were able to transect a portion of this cord lipoma while reducing the vast majority of it back within the peritoneal cavity.
** indirect inguinal defect
** mesh plug
** incision on the right side was subsequently closed
** attention to the left side
** fat-containing structure
** We separated these 2 structures,
** identified this as a cord lipoma, transecting a small portion of this cord lipoma and subsequently reducing the remainder through
the deep inguinal ring into the peritoneal cavity.
** large indirect defect was noted
** placed 1 large plug and 1 patch
Gross description:
SOFT TISSUE, LEFT CORD LIPOMA, REPAIR:Received in formalin and labeled
with the patient’s name, social security number, and "left cord lipoma"
Microscopic exam/diagnosis:
DIAGNOSIS:
SOFT TISSUE, LEFT SPERMATIC CORD, INGUINAL HERNIA REPAIR: LIPOMA.
I was asked a question from my staff and I was wondering what you thought. They Physician did the following two procedures and the office billed CPT 63661 with 2 units and 63662. Medicare processed 63662 but denied 63661 with 2 units. The office removed the 2 units and billed the 63661 with 1 unit. Medicare has denied "That single line item claim is now being denied because it requires a qualifying service to be done."
Please see the OP Note that I Received below
Postoperative Diagnoses:
1. Status Post Spinal Cord Stimulator implant with another provider
2. Failed back syndrome
3. Nonfunctioning spinal cord stimulator
Procedures Performed:
1. Removal of spinal cord stimulator paddle and leads
2. Via a separate incision removal of spinal cord stimulator battery pack
Description of Procedure: The patient was brought to the operating suite. She was placed under general anesthesia. Patient was flipped from supine to prone onto a chest, hip, thigh Jackson table, arms up in a superman position, all padded pressure points secured. X-ray fluoroscopy was brought in to draw out the midline paraspinal lumbar and the battery pack incisions that hopefully we would have to utilize, but we also drew out a thoracic incision in case we have to do a laminectomy if the leads were stuck. We infiltrated both incisions with Marcaine with Epinephrine. Preoperative antibiotics were given. Proper time-out was performed. Patient was prepped and draped in sterile fashion.
The lumbar incision para-midline was opened first and we used blunt dissection techniques to get the fascia, got down to the spinal cord leads. They were stapled in place, we removed that. We extracted leads from the thoracic epidural space and there was no rush of CSF and they came out easily. We cut those. We irrigated that wound with bacitracin infused saline. We closed the wound in anatomic layers with 0 Vicryl to the muscle, 0 Vicryl to the fascia, 2-0 Vicryl to the dermis, and Steri-Strips for the skin. Sterile dressing was applied.
Removal of spinal cord stimulator battery pack via separate incision: We made a separate incision in the left buttock area, dissected down to the capsule of the battery pack. We found the leads that we had cut earlier and pulled those through the tissues and the spinal cord stimulator was removed in its entirely, verified by x-ray. We extracted the battery out of the pack and copiously irrigated with bacitracin infused saline. We did essential tack up after assuring hemostasis to get the pocket to close down. We closed the wound in anatomic layers, 0 Vicryl for the fascia, 2-0 Vicryl for the dermis, and steri-strips for the skin. A sterile dressing was applied there. the patient was rolled from prone to supine and extubated without incident.
Was CPT 63661 and 63662 correct and should there be a modifier??
Thank You!!! It has been awhile since I have done Orthopedic.
Thanks!
Karen:eek:
He had a prior billing company that coded the same codes and are :
38205
38207
38208
38212
38214
38215
38240
All were billed on 4 lines. The 1st line was standard CPT code then the following 3 utilized 59 modifier. He should be able to code for these services as the lab/machine prepared the umbilical cord blood into stem cell and was frozen, preserved, thawed etc. Unfortunately the previous billing company informed him he could utilize the same pre-cert/pre-auth as the hospital! I’m not sure how they stay in business.
Does anyone have any information on this fairly new procedure? Obviously it is allogeneic as it is a different donor aka maternal mother!
The other downfall is the "old school" MD did not state how many CC’s/units utilized however it should state 4 cc’s so that is why I am believing they billed a total of 4 units ??
If someone has experience and can lead me to it, I would GREATLY appreciate it.
Thank you
I need assistance in coding for the removal of a spinal cord stimulator just 3 days later because the patient was not satisfied. The Dr coded a postop visit with the fluor 77003, but that doesn’t look right? Please help! Thanks!