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Need help with deep inguinal sentinal node bx with intraoperative mapping
Thank you!!
Carol J Self, CPPM, CPC, EMT
Intraoperative Cotton Test
POSTOPERATIVE DIAGNOSIS: Right ankle trimalleolar fracture dislocation.
PROCEDURE PERFORMED: Right trimalleolar fracture, open reduction and internal fixation with syndesmotic repair.
ORTHOPEDIC IMPLANTS USED.
1. Synthes stainless steel 1/3 tubular plate.
2. Synthes stainless steel 4.0 cannulated screws.
3. Synthes stainless steel 3.5 cortical lag screw.
4. Arthrex TightRope.
DESCRIPTION OF PROCEDURE: The patient identified the right lower extremity as the operative site. Consent was verified for the procedure. The patient was brought back to operating room #24 and placed under general anesthesia. All bony prominences were subsequently padded as the patient was given 2g of Ancef IV 30 minutes prior to starting the case. The right lower extremity was prepped with sterile ChloraPrep and draped in a sterilely appropriate fashion. Surgical procedure began with evaluation and inspection of the soft tissue envelope to the right lower extremity. There was severe soft tissue swelling, ecchymosis and soft tissue compromise distally, most likely due to continued ongoing swelling to the right lower extremity. Due to the patient’s skin condition, we potentially avoided the open formal approach to help minimize soft tissue complications. Based off the amount of soft tissue swelling and ecchymosis present at this time, it would still be at least 4 to 6 weeks before the patient would qualify for an open approach and as such, the fracture would have most likely healed and displaced position, so we proceeded with minimally invasive fixation.
Surgical procedure began with reduction of the right fibula. A small 2cm incision was placed directly over the fibula fracture. Pointed reduction clamp was inserted. A small stab incision was made distally as a 3.5 lag screw was then passed up the intramedullary canal of the right fibula into the proximal fibula. Anatomic length, alignment, rotation of the distal fibula was noted. The pointed reduction clamp was subsequently removed. A small incision was made directly over the medial malleolar fracture line and interposed periosteum was removed using a rongeur. Guidewires for 4.0 cannulated screws were then percutaneously passed across the fracture, achieving lag screw fixation of the medial malleolus. Intraoperative cotton testing was performed and syndesmotic injury was apparent. A one-third tubular plate was positioned directly over the lateral comminution of the fibula and anchored to the tibia using a cancellous screw. An Arthrex TightRope was then predrilled while syndesmotic reduction was maintained. The Arthrex TightRope was cinched, tightened and postoperative cotton test was negative at this time.
Intraoperative Ultrasound during Thyroidectomy
In all my 7 years of coding for ENT, this is the first time I’m coming across this and I wanted to know if what is being done is tip-toeing on the edge of over-utilization or not medically necessary….
Endo surgeon performs thyroidectomies and lobectomies all the time without any intraoperative ultrasound. All of the sudden now EVERY single case has included 76536 (Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation) and I’m concerned that this is not medically necessary. I haven’t been able to find a single scholarly article, coding article, or even Physician membership board mentioning that this is somehow routine (or even a new way of performing the surgery). I’ve worked with 2 different ENT groups and this is the first time I’m seeing them bill for 76536; 1-2 cases here and there, I can understand…this is literally every single patient on their list all of sudden.
Most of the documentation is verbatim in every op report and reads: "After induction of general endotracheal anesthesia, Intraoperative neck sonography was performed for incision site planning and to rule out interval development of malignant adenopathy or extrathyroidal extension of tumor. The patient was then prepped…"
Out of network billing for Intraoperative Neuromonitoring
Intraoperative Neuromonitoring
Intraoperative Fluoroscopy
Provider performed a close reduction right ankle with application of external fixator for a right ankle pilon fracture. In the operative report,…
Medical Billing and Coding Forum
Intraoperative Parathyroid Hormone monitoring
We have a physician trying to obtain pre-cert for a parthyroidectomy. She is asking for the cpt code for Intraoperative Parathyroid Hormone monitoring. I’m at a total loss.