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Doing so requires understanding the 2019 coding changes for reporting these two services during the same session. Effective Jan. 1, 2019, new CPT® codes were introduced to report fine needle aspiration (FNA) biopsies. Proper coding of these procedures starts with an understanding of the new codes, as well as how they affect reporting of core […]
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I have a provider wanting to use 36000 when we cannot bill for actual hydration or an infusion. I’m thinking this would also be when we are sending patients our via ambulance. Medicare and Tricare will not cover this code, but some commercial payers will. My other concern is that KVO is not separately reportable, and maybe this scenario falls under that category.
Also, 96365 states "up to 1 hour" but doesn’t specify a minimum like the other codes do. Is it ok to bill this code for less than 30 minutes when we are infusing an antibiotic?
Any help would be appreciated!!
Any help would be greatly appreciated.:confused:
Patient A
Date:
PREOPERATIVE DIAGNOSIS: Malignant-appearing lymphadenopathy of the left
upper neck.
POSTOPERATIVE DIAGNOSIS: Malignant-appearing lymphadenopathy of the
left upper neck.
PROCEDURE: Ultrasound-guided fine-needle aspiration of left neck lymph
node x2.
STAFF SURGEON: M.D.
PROCEDURE: After discussing the procedure with the patient, the left neck was prepped with Betadine prep swab. We then used
ultrasound to examine the left neck region, identified two packets of
lymph nodes, decided to biopsy the lower packet first. I placed a
25-gauge needle into the lymph node packet and aspirated until fluid
was in the hub. I then placed this onto a microscopic slide and spread
it between two different side slides, one was fixed and one was air
dried and I placed the remainder into the CytoLyt solution. I then
changed needle and syringes and aspirated a second higher level lymph
node packet until I got blood return into the hub of the needle.
Again, I placed this on to a slide and spread it between two separate
slides, one was air dried and one was fixed. The remaining solution
was placed into the CytoLyt solution. These were both sent to
pathology. We will await our biopsy results.
_____________________________
M.D.
CC:
PREOPERATIVE DIAGNOSIS: Malignant-appearing lymphadenopathy of the left
upper neck.
POSTOPERATIVE DIAGNOSIS: Malignant-appearing lymphadenopathy of the
left upper neck.
PROCEDURE: Ultrasound-guided fine-needle aspiration of left neck lymph
node x2.
STAFF SURGEON:
PROCEDURE: After discussing the procedure with the patient, the left neck was prepped with Betadine prep swab. We then used
ultrasound to examine the left neck region, identified two packets of
lymph nodes, decided to biopsy the lower packet first. I placed a
25-gauge needle into the lymph node packet and aspirated until fluid
was in the hub. I then placed this onto a microscopic slide and spread
it between two different side slides, one was fixed and one was air
dried and I placed the remainder into the CytoLyt solution. I then
changed needle and syringes and aspirated a second higher level lymph
node packet until I got blood return into the hub of the needle.
Again, I placed this on to a slide and spread it between two separate
slides, one was air dried and one was fixed. The remaining solution
was placed into the CytoLyt solution. These were both sent to
pathology. We will await our biopsy results.
PREOPERATIVE DIAGNOSIS: Foreign body in the left upper extremity.
POSTOPERATIVE DIAGNOSIS: Syringe needle in the left upper extremity.
NAME OF PROCEDURE: Removal of left upper extremity foreign body with fluoroscopic guidance.
ANESTHESIA: General.
FINDINGS: There was a TB needle stuck within the superficial vein in the left antecubital area. Fluoroscopy was used to confirm there were no other pieces of metal in that area following removal. There was a very cord-like vein underneath the vein that had the needle stuck in it.
TECHNIQUE: The patient was taken to the operating room and placed supine on the operating table. The left upper extremity was prepped and draped in a standard surgical fashion. Local anesthetic was injected over the area where the needle could be felt. A small incision was made at this location. Scissors were used to dissect down to the vein containing the needle. The vein was looped proximally and distally with a 2-0 silk suture. The vein was opened up with the scissors, and the hypodermic needle was removed with a hemostat. The 2 previously placed loop sutures were tied. There was no bleeding. Fluoroscopy was then used to confirm that no other metal objects could be seen in the antecubital space. The incision was then reapproximated with a running 4-0 Vicryl subcuticular stitch. The wound was cleaned and dried, and Steri-Strips were applied. The patient tolerated the procedure well.[/COLOR]
No documentation that she’d ever actually been exposed to bodily fluids. Tatoos don’t count as high-risk behavior. No other signs/symptoms, except fatigue.
Any ideas?
Thanks!
"Do you recall the reasoning for that? From my reading, I believe we should code 88307 for lymphoma work-up any time flow is done on the same node and/or IHC (to evaluate for a lymphoma) is done both of which were done on this specimen. I didnt see anything in the coding services handbook that would indicate whether it is a core biopsy vs excisional biopsy would make any difference.
The extra work that must be documented will include
at least one of the following: touch preparation or frozen section to assess specimen adequacy
and determine what, if any, special studies are appropriate; H&E sections beyond the number
typically associated with a lymph node biopsy; flow cytometry immunophenotyping; molecular
pathology; and/or immunohistochemistry."