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ostectomy- not indicated as partial or complete?

I’m coding a surgery from from procedure report (and hasn’t been dictated yet). They did not indicate whether the ostectomy was partial or complete. Is there a default to code when they don’t give you the information (like in icd-10) or would I need to request this information before I can code appropriately? The following is what’s on the procedure report:

excision and application of wound vac 6×5
ostectomy of the 4th and 5th metatarsal and cuboid
excision and intermediate closure 4cm lateral foot

anesthesia: MAC
diagnosis: wound to the right foot

Thanks for the help!

Medical Billing and Coding Forum

Spinal accessory nerve to suprascapular and partial radial to axillary nerve transfer

Hello,

I am new to ortho coding. I am trying to find the cpt codes for nerve transfers.

I came up with:

Spinal accessory nerve to suprascapular transfer 64713

Right partial radial to axillary nerve transfer 64999

I cannot find a code to compare the unlisted code to.

I would appreciate all the help. Here is the op-report. Thank you

The patient was identified in the preoperative holding area. We reviewed the operative indications, operative plan and recovery. The right shoulder was marked as the operative site and confirmed with the patient. He was then brought to the operating room. He was placed in the prone position. All bony prominences were well padded. Preoperative antibiotics were given per standard protocol. The right shoulder girdle and upper extremity was then prepped and draped in the normal sterile fashion.
A timeout was performed per standard protocol, identifying the patient, the procedure and the operative site. All personnel were in agreement and there were no discrepancies identified.
A transverse incision was made over the superior aspect of the scapula, beginning medial to the superior angle and eventually extending over the acromion. The incision was taken through skin, subcutaneous tissue and fascia down to the trapezius muscle. The fibers of the trapezius were split transversely to identify the spinal accessory nerve. Once we identified the nerve, we used a nerve stimulator to confirm its identity and its function. We carried our dissection laterally to identify the suprascapular nerve. We had difficulty identifying the suprascapular nerve. Proximally, we identified a section of the nerve, proximal to the notch, that appeared damaged. We carried our dissection distally to the acromion and the spinoglenoid notch. Unfortunately, the nerve was not identified in the notch despite wide exposure, suggesting that perhaps the nerve was avulsed distally, with the spinoglenoid notch serving as a second tethering point.
*
We decided at this point to revisit the suprascapular nerve at a later time and instead to continue with the partial radial nerve to axillary transfer. The incision was extended longitudinally over the posterior aspect of the arm. The incision was taken through the skin, subcutaneous tissue and fascia down to the triceps. The radial nerve was identified in the triangular space. We identified its branches, and used a nerve stimulator to evaluate the function of each branch. We selected the branch that provided only elbow extension as our donor nerve; another branch that provided wrist extension was preserved. We then carried our dissection proximally to the quadrangular space to identify the axillary nerve. We isolated the anterior motor branch. The donor radial nerve was divided as distal as possible, and the axillary nerve was divided as proximal as possible. The microscope was then brought into the operating field. The nerve ends were prepared and coapted under the microscope using 8-0 Nylon sutures. The repair was reinforced with fibrin glue (Eviseal).
*
We turned our attention back to the suprascapular nerve. Again, we found that the proximal portion of the nerve appeared unhealthy, and distally it was absent from the spinoglenoid notch. As such, a spinal accessory to suprascapular nerve transfer would be nonfunctional, and we abandoned this second nerve transfer, deciding it was best to preserve trapezius function as it was one of the few stabilizing muscles remaining around his shoulder.

Medical Billing and Coding Forum

Occupational therapy partial denial on multiple codes

I am new to billing occupational therapy codes and received a partial denial for the 2nd and 3rd codes for 1 visit. Denial on claim is as follows: 59 – Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules.

I am billing 97110, 97530, and 97535 with a GO modifier. The adjusted reimbursement is about 25% less than the agreed rate.

Is there anyway to get full payment? Should I be using modifier 59?

Medical Billing and Coding Forum

Prolapsed Colostomy, partial colectomy, new ileostomy

Hello,
I am having a difficult time settling on this case. Any advice would be much appreciated!
I have the scrubbed op note below:

DIAGNOSIS: Prolapsed sigmoid colostomy.

PROCEDURE PERFORMED: Excision prolapsed colon with re-maturation and new
spot of end Brooke ileostomy.

ESTIMATED BLOOD LOSS: Minimal.

SPECIMEN: Right colon.

IMMEDIATE COMPLICATIONS: None.

DESCRIPTION OF PROCEDURE: The patient was taken to the operating room and
placed in the supine position on the operating room table. Time out session was
successfully conducted. The area was prepped and draped in the usual sterile
fashion. Incision was made around the colostomy itself and carried down through
subcutaneous tissue using Bovie electrocautery. The colostomy, the prolapsed
portion and the healthy portion were then freed entirely from the skin and was
advanced forward and approximately 4-5 inches in, the appendix was identified,
indicating the end of the colon. This was pulled entirely into the wound and
inspection of the colon revealed approximately 3-4 inches of healthy colon. I
consulted a colleague for an intraoperative consult to discuss whether or not
salvage of this colon was appropriate in this setting for possible reanastomosis in
the future. We had a discussion and the decision was made to create a new sited end
Brooke ileostomy as there was not sufficient colon for solid stool. The 10 mm
LigaSure was then used to take down the mesocolon to the level of the cecum. A
GIA-75 stapler was then used to come across the terminal ileum proximal to the
ileocecal valve in preparation for creation of the ostomy. This specimen was sent
as right colon with prolapsed right colon intussusception. A place was chosen
cephalad to the old site as it was herniated and was not good for the ostomy
caliber. A small circular incision was made and a cruciate incision was made
through the rectus fascia itself until the ostomy was pulled through with the
Babcock. This was placed on the skin. The old ostomy site was sharply debrided. A
running looped 0 Prolene suture was used to close the fascia of the old ostomy site.
Staples were placed in the skin leaving a gap and it was packed with quarter inch
iodoform gauze. The ostomy was then matured on the skin with interrupted 3-0 Vicryl
sutures in a rosebud fashion. Ostomy device was placed and the procedure was
terminated. Needle, sponge and instrument counts were correct at the end of the
procedure. The patient tolerated the procedure well.

My point of concern is this:
44346: Does not mention relocating the stoma (especially converting to ileostomy)
44345: Does mention relocating the colostomy stoma, however this is now converted to an ileostomy.

Would I code closure of colostomy, partial resection of colon, ileostomy all separate?
That doesn’t seem right either…

Charge sheet shows: 44160, 44312

I am probably overthinking this. 😮
Please help!
Thank you for your time!
~Melissa

Medical Billing and Coding Forum

Partial Colectomy with delayed colostomy due to complication

Any guidance will be greatly appreciated…

My surgeon took a patient to the OR and completed partial colectomy of the transverse and descending colon. The patient began having cardiac issues and the operation had to be halted prior to any anastomosis or stoma creation. They covered his open abdomen with a negative pressure dressing and towels and placed a drain then an airtight seal.

The next day he was taken back to the OR – negative pressure dressings removed and abdomen explored. They performed partial omentectomy, created end colostomy and matured it. the abdominal wound was packed with wet Kerlix and ABD pads.

Should I use code:
Day 1:
44141 with -53 to indicate the discontinuance of the initial procedure?
44139 mobilization of splenic flexure (clearly documented in op note)
97607 for negative pressure dressing

Day 2:
44320-58 or 44141-52-58 for the colostomy creation for?
49255 for omentemtectomy day 2?

Thank you in advance

Medical Billing and Coding Forum

Coding a Partial Mastectomy with SNB and axillary lymph node dissection.

Can I code this 19302,LT, 38745,59 with 38525,59 ?????

PREOPERATIVE DIAGNOSIS: Left breast carcinoma.

POSTOPERATIVE DIAGNOSIS: Left breast carcinoma.

PROCEDURES PERFORMED:
1.Left partial mastectomy with ultrasound localization.
2.Left axillary sentinel lymph node biopsy.
3.Left completion axillary lymph node dissection.

ANESTHESIA: MAC.

ANESTHESIOLOGIST: XXXX

SURGEON: XXXX
ASSISTANT: XXX

INDICATIONS FOR PROCEDURE: 53-year-old female with a newly diagnosed left breast carcinoma. She has a clinically normal axilla. She is undergoing a partial mastectomy with axillary sentinel node sampling at this time. Risks and benefits were explained including bleeding, infection, tumor recurrence, need for additional margin resection, arm edema, nerve injury, and indications for completion axillary lymph node dissection. All questions were answered. She desires to proceed. A surgical assistant is standard, necessary, and customary for the safe performance of this procedure.

DESCRIPTION OF PROCEDURE: Monitored anesthesia care was started upon returning from lymphoscintigraphy. Intraoperative ultrasound was utilized to identify the 3 o’clock tumor. The breast and axilla were infiltrated with 1% lidocaine and 0.5% Marcaine. The axilla was initially opened. Multiple hot lymph nodes were present. The highest activity was noted to be 20,000 units on the gamma counter. Subsequent nodes measured 2000 units with background activity all being negligible less than 200 units. The identified hot lymph nodes were all dissected using electrocautery and sent for frozen sectioning. A total of five hot lymph nodes were present, two of which were grossly positive for metastatic breast carcinoma. The axilla was subsequently extended allowing for completion dissection to be performed. The axillary vein was identified and skeletonized inferiorly. The long thoracic nerve and thoracodorsal nerves were both identified and preserved. The intercostal brachial nerve was diminutive in size and difficult to separate from the surrounding fibrofatty tissue. This was intentionally divided during the dissection. The axillary contents were peeled inferiorly and sent for permanent sectioning. Upon completion, the long thoracic and thoracodorsal nerves were confirmed intact and functional. The axillary vein was noted to be hemostatic. The axilla was closed in layer over a #10 flat Jackson-Pratt drain followed by Dermabond.

The breast was incised through a 3 o’clock periareolar incision. Ultrasound was used to guide the dissection. Using electrocautery, a large core of tissue was taken enveloping the entire mass. This was excised ex vivo. Subsequent Ultrasound confirmed the mass centrally located with multiple centimeters of normal surrounding breast parenchyma with the clip easily identified centrally. Satisfactory hemostasis was assured throughout the breast cavity. Additional portions of all six margins were obtained and sent for permanent sampling. The breast had been completely skeletonized from beneath the skin leaving no additional breast tissue to be had at this location. Portions of the pectoralis major fascia were also included. Hemostasis was assured. The defect was closed in layers with absorbable suture followed by Dermabond. Multiple clips had been placed circumferentially around the cavity to allow consideration for postoperative partial breast radiation. The patient was taken to Recovery awake and uneventfully.

Medical Billing and Coding Forum

Partial IUD Removal

I’m expecting push back when I provide a response to a doctor in our practice. I wanted to get the opinion of someone more experienced then myself.

Scenario –
Last month, patient came in for an IUD removal. Only a portion of the IUD was removed as an arm was lodged in the uterus.

I would code this as a filed IUD removal, 58301-53

At a later date the patient came in and the arm was removed via hysteroscopy.

I would code this as 58562.

The doctor wanted to use 58301-53 and then 58301 for the second visit. What is the correct coding for this scenario?

Medical Billing and Coding Forum