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Click here for more sample CPC practice exam questions and answers with full rationale

IStent repositioning

We have a physician that did an IStent repositioning for a dislocated stent and added a second IStent. According to our IStent rep, the code to use for the repositioning is 66999 (Unlisted procedure, anterior segment of eye). We are under the impression that this is not a payable code. The rep also stated that there is no ASC payment for this code but there is HOPD payment. It does not state anything about payment for the physician.

Any thoughts on this would be appreciated!

Medical Billing and Coding Forum

Repositioning breast implant with flap revision

Pt completed breast reconstruction as of April 2017, however implant were malpositioned and returned to revise breast by replacing implant, revising dog ear from previous breast reduction, revising flap. Would we bill 19340 with 19380 or only 19340? I’m just unsure if 19380 may be billed with other codes, encoder coding tip says when billing 19380:

If an existing breast prosthesis is replaced, it may be reported separately, see 19340.

Medical Billing and Coding Forum

Chest Tube Repositioning

I am trying find the right code for a patient that had a chest tube placed, but then had to have it repositioned during the global period. Provider A originally placed the chest tube, but then provider B, from the same practice, removed and repositioned the chest tube, using the original incision. Can provider B code the removal and also the insertion if modifier 77 or 78 were added?

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informed consent from patient timeout was called and #24 French chest tube was prepped and the previous chest tube was withdrawn without any difficulties.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.

Medical Billing and Coding Forum