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Multiple surgery help

Having issues figuring out the coding for the following procedures…the CABG and AVR are not a problem, but the surgeon did a TAA repair, Right innominate to subclavian bypass grafting w/ORIF of sternoclavicular joint with fusion. Not something typical with our practice.

PREOPERATIVE DIAGNOSES: Aortic stenosis, ascending aortic aneurysm,
intermittent atrial fibrillation, coronary artery disease, right arm
subclavian stenosis, peripheral vascular disease, diabetes, hypertension,
hyperlipidemia, obesity, COPD.

POSTOPERATIVE DIAGNOSES: Aortic stenosis, ascending aortic aneurysm,
intermittent atrial fibrillation, coronary artery disease, right arm
subclavian stenosis, peripheral vascular disease, diabetes, hypertension,
hyperlipidemia, obesity, COPD.

PROCEDURE:
1. Coronary artery bypass graft x3, LIMA to LAD, reverse saphenous vein
graft to obtuse marginal 2 and posterior descending artery.
2. Aortic valve replacement with 25 mm Edwards Magna Ease pericardial
tissue valve.
3. Left atrial appendage clipping.
4. Thoracic aortic aneurysm repair.
5. Right innominate to subclavian bypass grafting.
6. ORIF of sternoclavicular joint with fusion.
7. Greater saphenous vein endoscopic venous harvesting.
8. Right femoral central venous catheter placement.

FINDINGS:
1. Heavily calcified bicuspid aortic valve.
2. Heavily calcified ascending aorta with need for removal of individual
plaques.
3. Mildly depressed ejection fraction pre and postop approximately 40%.
4. Posterior descending artery approximately 1.75 mm vessel, LAD 2 mm
vessel, obtuse marginal 1.25, greater saphenous vein from the left leg with
poor quality of the distal leg.
5. Mammary severely adhesed with an area requiring repair in its proximal third innominate artery clear, heavy calcifications at a bifurcation takeoff
of the subclavian artery with a dilated subclavian artery proximally, a good
quality subclavian artery distally at the mid third of the clavicle.
Triphasic subclavian signal post-bypass, complication injury to the superior
vena cava during tunneling of the graft requiring increased exposure and
disarticulation of the sternoclavicular joint on the right.

PROCEDURE: The patient was taken to the operating room, placed under
anesthesia with Swan-Ganz catheter, endotracheal tube and transesophageal
echo, the right shoulder, entire chest, abdomen, lower extremities were
sterilely prepped and draped in the usual manner. Greater saphenous vein is
harvested from the left leg by endoscopic venous harvesting technique.
Proximal and distal vein were ligated. All side branches were clipped and
divided. The vein was closed in a layered fashion with absorbable suture.
Simultaneously, the sternum was opened via median sternotomy. Left internal
mammary artery was harvested as a pedicle graft. All side branches were
clipped and divided distally, it was clipped and divided after the patient
was given systemic heparinization. The innominate vein was dissected out as
was the innominate artery which is very tortuous, this was dissected out in
the midline and dissected out to its bifurcation of the right carotid and
subclavian bifurcation, which was noted to have heavy calcifications. At
this point, a counter incision was made in the mid third of the clavicle on
the right with an incision inferior to the clavicle. Vessels were dissected
out and isolated. At this point, tunneling was being created between the 2
points. There was noted bleeding behind the sternoclavicular joint area.
This was unable to be exposed requiring disarticulation of the sternum from
the clavicle. At this point, the inferior vena cava and a few branches were
noted to be bleeding. These were suture ligated with pledgeted Prolene for
reinforcement. At this point, the patient was placed on cardiopulmonary
bypass with aortic arterial and right arteriovenous line. An aortic root
vent was placed as was a right superior pulmonary vein, a left ventricular
vent and a right atrial retrograde cardioplegic cannula. While on bypass,
the aorta was cross clamped noting the aneurysm approximately 5 cm just
distal to the aortic valve and tapered proximal to the innominate artery
takeoff. The aorta was crossclamped, heart was arrested with antegrade and
retrograde cardioplegia. Retrograde cardioplegia was continued for the
remainder of the case for cardioprotection. Distal was performed with the
vein graft end-to-side manner to the posterior descending artery. This was
sequenced in a side-to-side manner to the second obtuse marginal. Final
distal was LIMA to LAD in its distal third performed with running 7-0
Prolene suture. Left atrial appendage was evaluated inspected and a leftpoint,
an aortotomy was performed superior to the aortic valve. The valve
was bicuspid heavily calcified and stenotic. Upon entering the aorta as
well, there were large plaques along the walls of the ascending aorta. Some
of these were removed to prevent distal embolization. The valve leaflets
were excised and decalcified. Due to the heavy nature of plaquing and the
bicuspid nature and some of the plaques extended onto the anterior leaflet
of the mitral valve, it was decided to place surgical valve with pledgeted
Prolene sutures on the ventricular side. The valve was sized to 25 and an
Edwards Magna Ease valve pericardial tissue was placed. Once this was
seated, after decalcification of the annulus and irrigation and removal of
all debris, the valve was then placed. At this point, the aneurysm was
measured, portion of the aorta was excised removing the aneurysm and the
remainder of the aorta was reapproximated in a double layer fashion as an
aneurysmorrhaphy. With this in place, the proximal anastomosis was placed
on the remaining ascending aorta end-to-side fashion with running 6-0
Prolene suture. Heart was rewarmed, cardiac activity resumed and aortic
crossclamp was removed. Next, the subclavian artery was isolated, clamped
proximally and distally arthrotomy performed, end-to-side anastomosis
created and using a 6 mm Gore-Tex ringed graft and running 5-0 Prolene
suture. This was next anastomosed to be tortuous innominate artery with a
side-biting clamp, again using a running 5-0 Prolene suture. Once prior to
completing the anastomosis, all vessels were allowed to backbleed for
removal of air or debris. There had been some plaquing noted within the
innominate artery at the proximal portion of the subclavian takeoff. A
small portion of this was removed. Next, with cardiac activity resumed, the
patient was weaned from cardiopulmonary bypass. The aortic valve was
inspected intraoperatively by cardiology review. Heparinization was
reversed using protamine sulfate. All cannulas were removed and reinforced
with pledgeted Prolene suture. Atrial and ventricular pacing wires were
placed as well as bilateral pleural chest tubes. A mediastinal chest tube
and a mediastinal JP drain. Once hemostasis had been verified, the
pericardium was loosely reapproximated in the midline without complete
coverage of the right ventricle and the sternum was Pulsavac with antibiotic
irrigation and closed with #6 sternal wire. Prolene suture was used for
closure of the upper abdominal fascia. The clavicle and manubrium were
reapproximated with a #6 sternal wire and then to seat both bones and fuse
the joint, a plate was placed using screws spanning from the upper end of
the manubrium over onto the clavicle. The bypass of the innominate
subclavian bypass was inspected. Hemostasis verified. Once all wounds were
verified with to be hemostatic. The thoracic fascia was reapproximated in the midline
and the pec muscle reapproximated over the subclavian exposure.
The remainder of the wounds were closed in layered fashion with absorbable
suture and a Prevena wound VAC was placed and due to the need for inotropic
support and large volume resuscitation and prolonged procedure, a right
femoral venous catheter was placed by modified Seldinger technique for
additional venous access. The patient was subsequently transported to
intensive. A chest x-ray was taken in the operating room as Ray-Tec count
was not correct. Lap and instrument count was correct. X-ray showed no
evidence of retained foreign body and once the patient was draped and moved
the missing Ray-Tec was identified in the drape. The patient tolerated the
procedure. We will continue with supportive care.

The surgeon provided 33405, 33533,51, 33518, 33860,51…I feel he missed the ORIF and the subclavian bypass grafting, but I could be wrong!

Any help is appreciated!

Medical Billing and Coding Forum

Multiple surgery help

Having issues figuring out the coding for the following procedures…the CABG and AVR are not a problem, but the surgeon did a TAA repair, Right innominate to subclavian bypass grafting w/ORIF of sternoclavicular joint with fusion. Not something typical with our practice.

PREOPERATIVE DIAGNOSES: Aortic stenosis, ascending aortic aneurysm,
intermittent atrial fibrillation, coronary artery disease, right arm
subclavian stenosis, peripheral vascular disease, diabetes, hypertension,
hyperlipidemia, obesity, COPD.

POSTOPERATIVE DIAGNOSES: Aortic stenosis, ascending aortic aneurysm,
intermittent atrial fibrillation, coronary artery disease, right arm
subclavian stenosis, peripheral vascular disease, diabetes, hypertension,
hyperlipidemia, obesity, COPD.

PROCEDURE:
1. Coronary artery bypass graft x3, LIMA to LAD, reverse saphenous vein
graft to obtuse marginal 2 and posterior descending artery.
2. Aortic valve replacement with 25 mm Edwards Magna Ease pericardial
tissue valve.
3. Left atrial appendage clipping.
4. Thoracic aortic aneurysm repair.
5. Right innominate to subclavian bypass grafting.
6. ORIF of sternoclavicular joint with fusion.
7. Greater saphenous vein endoscopic venous harvesting.
8. Right femoral central venous catheter placement.

FINDINGS:
1. Heavily calcified bicuspid aortic valve.
2. Heavily calcified ascending aorta with need for removal of individual
plaques.
3. Mildly depressed ejection fraction pre and postop approximately 40%.
4. Posterior descending artery approximately 1.75 mm vessel, LAD 2 mm
vessel, obtuse marginal 1.25, greater saphenous vein from the left leg with
poor quality of the distal leg.
5. Mammary severely adhesed with an area requiring repair in its proximal third innominate artery clear, heavy calcifications at a bifurcation takeoff
of the subclavian artery with a dilated subclavian artery proximally, a good
quality subclavian artery distally at the mid third of the clavicle.
Triphasic subclavian signal post-bypass, complication injury to the superior
vena cava during tunneling of the graft requiring increased exposure and
disarticulation of the sternoclavicular joint on the right.

PROCEDURE: The patient was taken to the operating room, placed under
anesthesia with Swan-Ganz catheter, endotracheal tube and transesophageal
echo, the right shoulder, entire chest, abdomen, lower extremities were
sterilely prepped and draped in the usual manner. Greater saphenous vein is
harvested from the left leg by endoscopic venous harvesting technique.
Proximal and distal vein were ligated. All side branches were clipped and
divided. The vein was closed in a layered fashion with absorbable suture.
Simultaneously, the sternum was opened via median sternotomy. Left internal
mammary artery was harvested as a pedicle graft. All side branches were
clipped and divided distally, it was clipped and divided after the patient
was given systemic heparinization. The innominate vein was dissected out as
was the innominate artery which is very tortuous, this was dissected out in
the midline and dissected out to its bifurcation of the right carotid and
subclavian bifurcation, which was noted to have heavy calcifications. At
this point, a counter incision was made in the mid third of the clavicle on
the right with an incision inferior to the clavicle. Vessels were dissected
out and isolated. At this point, tunneling was being created between the 2
points. There was noted bleeding behind the sternoclavicular joint area.
This was unable to be exposed requiring disarticulation of the sternum from
the clavicle. At this point, the inferior vena cava and a few branches were
noted to be bleeding. These were suture ligated with pledgeted Prolene for
reinforcement. At this point, the patient was placed on cardiopulmonary
bypass with aortic arterial and right arteriovenous line. An aortic root
vent was placed as was a right superior pulmonary vein, a left ventricular
vent and a right atrial retrograde cardioplegic cannula. While on bypass,
the aorta was cross clamped noting the aneurysm approximately 5 cm just
distal to the aortic valve and tapered proximal to the innominate artery
takeoff. The aorta was crossclamped, heart was arrested with antegrade and
retrograde cardioplegia. Retrograde cardioplegia was continued for the
remainder of the case for cardioprotection. Distal was performed with the
vein graft end-to-side manner to the posterior descending artery. This was
sequenced in a side-to-side manner to the second obtuse marginal. Final
distal was LIMA to LAD in its distal third performed with running 7-0
Prolene suture. Left atrial appendage was evaluated inspected and a leftpoint,
an aortotomy was performed superior to the aortic valve. The valve
was bicuspid heavily calcified and stenotic. Upon entering the aorta as
well, there were large plaques along the walls of the ascending aorta. Some
of these were removed to prevent distal embolization. The valve leaflets
were excised and decalcified. Due to the heavy nature of plaquing and the
bicuspid nature and some of the plaques extended onto the anterior leaflet
of the mitral valve, it was decided to place surgical valve with pledgeted
Prolene sutures on the ventricular side. The valve was sized to 25 and an
Edwards Magna Ease valve pericardial tissue was placed. Once this was
seated, after decalcification of the annulus and irrigation and removal of
all debris, the valve was then placed. At this point, the aneurysm was
measured, portion of the aorta was excised removing the aneurysm and the
remainder of the aorta was reapproximated in a double layer fashion as an
aneurysmorrhaphy. With this in place, the proximal anastomosis was placed
on the remaining ascending aorta end-to-side fashion with running 6-0
Prolene suture. Heart was rewarmed, cardiac activity resumed and aortic
crossclamp was removed. Next, the subclavian artery was isolated, clamped
proximally and distally arthrotomy performed, end-to-side anastomosis
created and using a 6 mm Gore-Tex ringed graft and running 5-0 Prolene
suture. This was next anastomosed to be tortuous innominate artery with a
side-biting clamp, again using a running 5-0 Prolene suture. Once prior to
completing the anastomosis, all vessels were allowed to backbleed for
removal of air or debris. There had been some plaquing noted within the
innominate artery at the proximal portion of the subclavian takeoff. A
small portion of this was removed. Next, with cardiac activity resumed, the
patient was weaned from cardiopulmonary bypass. The aortic valve was
inspected intraoperatively by cardiology review. Heparinization was
reversed using protamine sulfate. All cannulas were removed and reinforced
with pledgeted Prolene suture. Atrial and ventricular pacing wires were
placed as well as bilateral pleural chest tubes. A mediastinal chest tube
and a mediastinal JP drain. Once hemostasis had been verified, the
pericardium was loosely reapproximated in the midline without complete
coverage of the right ventricle and the sternum was Pulsavac with antibiotic
irrigation and closed with #6 sternal wire. Prolene suture was used for
closure of the upper abdominal fascia. The clavicle and manubrium were
reapproximated with a #6 sternal wire and then to seat both bones and fuse
the joint, a plate was placed using screws spanning from the upper end of
the manubrium over onto the clavicle. The bypass of the innominate
subclavian bypass was inspected. Hemostasis verified. Once all wounds were
verified with to be hemostatic. The thoracic fascia was reapproximated in the midline
and the pec muscle reapproximated over the subclavian exposure.
The remainder of the wounds were closed in layered fashion with absorbable
suture and a Prevena wound VAC was placed and due to the need for inotropic
support and large volume resuscitation and prolonged procedure, a right
femoral venous catheter was placed by modified Seldinger technique for
additional venous access. The patient was subsequently transported to
intensive. A chest x-ray was taken in the operating room as Ray-Tec count
was not correct. Lap and instrument count was correct. X-ray showed no
evidence of retained foreign body and once the patient was draped and moved
the missing Ray-Tec was identified in the drape. The patient tolerated the
procedure. We will continue with supportive care.

The surgeon provided 33405, 33533,51, 33518, 33860,51…I feel he missed the ORIF and the subclavian bypass grafting, but I could be wrong!

Any help is appreciated!

Medical Billing and Coding Forum

Cardiology/Cardiothoracic/Vascular surgery coder

Misty Dawn Sebert CPC, CCC, CCVTC

509-435-6585 [email protected] https://www.linkedin.com/in/mistysebertcardiologycoder/

Open to FT, PT or Contract Position

Certified Cardiology and Cardio-thoracic coder with 8+ years of experience specialized in Cardiology coding.

Specialized and knowledgeable in coding: • ICD-10-CM •Diagnostic Cardiology •Interventional Cardiology

•Electrophysiology Cardiology •Pediatric Cardiology •Vascular and Thoracic Cardiology procedure coding.

Pro-fee & Outpatient/same day surgery • Interventional Radiology • EM.

Trained in many EHR systems such as EPIC, Meditech, Athena, 3M, Cerner & Nextgen

Owner/Certified Cardiology and Cardiothoracic Coder (CPC, CCC, CCVTC) at Sebert Consulting
April 2013 – Present (4 years 7 months)

  • Independent contract coder for physician practices, hospitals and universities throughout the United States either provided directly or through revenue consulting groups needing a cardiology coding specialist.
  • Specialized and knowledgeable in cardiology procedure/surgery coding for example:

Interventional Cardiology/Radiology – Coronary stents; VADs; TAVR/TAVI; Peripheral (Upper, Lower, Abdominal and Renal) Angiography, Angioplasty and Stents; Patent Foramen Ovale Closure, Ventricular Septal Defect Closure, Left Atrial Appendage Occlusion, Pericardiocentesis, Endovascular thoracic and abdominal aortic stent graft, Endovascular iliac stent graft…
Diagnostic Cardiology- Cardiac catheterization (coronary angiogram); CervicoCerebral, Descending Thoracic Aorta, Visceral, Upper extremity, Lower extremity and Abdominal angiography; Electrocardiogram; Cardiac stress testing; Echocardiogram (TTE); Transesophageal echocardiogram (TEE); Thallium scans/myocardial perfusion scans, IntraCardiac echocardiography…
Electrophysiology Cardiology- Electrophysiology study; Ablations; Holter monitor; Event monitor; Loop recorder; Pacemaker and lead procedures; ICD and lead procedures; Subcutaneous Cardioverter-defibrillator; Device Clinic/follow up coding…
Vascular and Thoracic Cardiology- CABGs, Valve Replacement, ECMO, VADs, Heart and lung transplants, thorascopy Procedures (Vats), Endovascular thoracic and abdominal aortic stent graft, endovascular iliac stent grafts…

  • Pro Fee cardiology EM- Office, Outpatient and Inpatient, Teaching Physician, Residents, Critical Care.
  • Providing expertise in the areas of backlog support, coding, denial management, training and development

of in-house providers and coders.

  • ICD 10 proficiency exam in March 2014.

Independent Cardiology Coding Consultant at The Coding Network
March 2013 – August 2015 (2 years 6 months)

  • ICD-10 Proficient continuous training and dual coding since March 2014 • Trained in many EMR systems such as EPIC, Athena & Nextgen
  • Coding of surgical procedures performed by cardiologists such as heart catheterization, coronary interventions, pacemakers, peripheral vascular procedures, Electrophysiology Ablations, EP Studies, Device Implants, Device Checks; Interventional Cardiology, Peripheral (Upper, Lower, Abdominal and Renal) Angiography, Angioplasty and Stents and Diagnostic Echo, Nuclear, TEEs; E&M. Aortic Endograft Clinic, TAVRs and VADs to name a few.
  • Help line services for cardiology specific coding, documentation and denial questions for staff, coders and physicians quickly and accurately.
  • Rules and regulations of Medicare billing including (but not limited to) incident to, teaching situations, shared visits, consultations and global surgery
  • Ability to read and abstract physician office notes and operative notes to apply correct ICD-9-CM, CPT®, HCPCS Level II and modifier coding assignments • Evaluation and management (both the 1995 and 1997 Documentation Guidelines) • Medical terminology • Anatomy and physiology

Certified Cardiology Coder at Providence Spokane Heart Institute
January 2009 – October 2014 (5 years 10 months)

  • ICD-10 Training completed
  • EPIC Resolute biller and coder trained
  • outpatient and physician office coding, Coding medical records with ICD-9, CPT-4, and HCPCS Level II coding.
  • Coded a wide variety of medical claims including Electorphysiology-Abalations, EP Studies, Device Implants, Device Checks; Interventional Cardiology-Coronary HTC and Stents; Peripheral (Upper, Lower, Abdominal and Renal) Angiography, Angioplasty and Stents and Diagnostic Echo, Nuclear, TEEs; E&M.
  • Coding for Aortic Endograft Clinic.
  • Research Coding for numerous cardiology research studies such as Corvalve/TAVR procedures.
  • Coding of surgical procedures performed by cardiovascular and thoracic surgeons such as cardiopulmonary bypass, PTCA, lung tumor ablation, etc.
  • Research correct code usage and prepare Coding Memo guidelines for coding staff on yearly coding updates and emerging cardiovascular procedures.
  • Assisting Doctors and staff with documentation and coding regulations. Successful work on denials and appeals.
  • Performed a variety of key patient-relations functions, responsible for handling and updating time sensitive and confidential files, communicating with local Hospitals to ensure accuracy and timeliness.
  • Work in numerous departments as needed such as assisting NWHL Cardio/Thoracic Surgeons coding department with coding while they were short staffed, worked with our Device clinic assisting EP staff with recording device data (thresholds, impendence and results) into medical records. Training new Device clinic staff on understanding and entering device data and appropriate coding of device checks. Diagnostic/Nuclear department coding an average 400 Echo/TEE and Nuclear bi-weekly. Training staff members correct coding of these diagnostics. Medical Records department following HIPPA regulation, Scanning and updating records and Records Request.

Docketing Assistant at Lee & Hayes, PLLC – Spokane, Washington
June 2002 – June 2007 (5 years 1 month)
Provide high-level administrative support to 20+ patent attorneys and executive level staff of leading Intellectual Property Law firm.
Performed a variety of key client-relations functions, responsible for handling and updating time sensitive and confidential files, communicating with United States Patent Department to ensure accuracy and timeliness. Maintained company and client databases. Developed spreadsheets to improve and inform supervisors of workflow trends. Recorded, updated, and reported daily all client imposed and legal deadlines.


Certifications

Certified Cardiovascular and Thoracic Surgery Coder (CCVTC™)
AAPC November 2014
Certified Cardiology Coder (CCC™)
AAPC December 2012
Certified Professional Coder (CPC®)
AAPC August 2010
ICD-10 Proficient
AAPC March 2014

Organizations

National Association of Professional Women
April 2015 to Present
AAPC American Academy of Professional Coders
April 2010 to Present

Education

MSU-Northern
Accounting and Business/Management
Spokane Community College
Medical Office Assistant/Specialist

Medical Billing and Coding Forum

Definition of minor surgery vs major surgery in medical decion making E/M

Can someone point me to a CMS definition of what these two terms mean? Is major surgery based on the 90 day global and minor surgery on the 10 day global or no global at all?

If you have a definitive link to something that would point me in the right direction, I would appreciate it since I am working thru audits right now and want to be sure I am interpreting this part of the E/M audit correctly.

Thank you!

Medical Billing and Coding Forum

Quality Medical Uniforms, Not Cosmetic Surgery

The issue on offering a cosmetic surgery in wanting to retain and recruit nurses is gaining more popularity now. A nurse may choose from a range of plastic surgery options, which include silicone-enhanced breasts, liposuction, and tummy tuck. But is that really the solution on the nursing shortage? Or the solution on the growing pressure of looking good? How about dressing in a fashionable way to enhance your assets? There are lots of stylish medical uniforms from which nurses can choose to look and feel good about themselves.

Honestly, the offer of cosmetic surgery is degrading to the more dedicated nurses. The nursing profession is a noble work that must not be viewed as a mere source of income, much more as a way to look good. As you can see, many people wanting to journey in the same road, ideally reason out of providing patients better health care services to reverse some things. Most of them personally or their loved ones suffered from low quality medical care at some point, and they don’t want more people experience the same way. When one enters a job, availing of incentive is a given factor, and so as benefits. But the real and primary reason is to practice the profession and extend a hand to people with ailments. Not the other way around.

Although, cosmetic surgery can be viewed as gift or incentive similar to a car, the mere fact that it is offered in order to retain and recruit nurses is a totally different story. In a situation wherein a nurse is no longer happy about the job and has already decided to leave, has to be offered of a cosmetic surgery, just so he or she stays, is saying that the only reason of staying is the beauty package. It has nothing to do with the profession at all. Or perhaps, the profession comes only as the second reason.

Why not focus on things that will benefit all nurses in general, such as improving health benefits and working condition? Providing at least the medical uniforms supply will actually ease the burden of nurses. And if equaled with better health benefits in a better working state, and with a considerably good compensation, all will be well. No need to offer fancy things. Besides, if a hospital can spend on cosmetic surgeries, why not spend on things that nurses have longed for quit a long time already?

Let’s say, a hospital is $ 3,500 for cosmetic breast surgery of just one person. Can that amount of money not be spent of medical scrubs, scrub pants, lab coats, and the likes? For that amount, a hospital can provide $ 9.95 worth of decent Cherokee medical scrub tops for 351 persons. That’s not even the cheapest, for there are quality medical scrubs available for as low as $ 6.95. Now, for the budget allotted on the breast augmentation of 20 persons, over 10,000 scrub tops can be purchased. That’s 5 pieces of scrub tops for 2,000 employees. They can be used for several months. And everyone will benefit.

If purchased from a store like Pulse Uniform, which offers free shipping on every $ 75 order, there’s no need to worry about delivery cost. On top of it all, these people can look and feel good on these medical uniforms, so there’s no need to really opt for undergoing plastic surgery.

Mecheil is a product consultant for medical uniforms at http://www.pulseuniform.com/medical-uniform.asp Check our featured brands and complete line of the latest medical scrub designs at http://www.pulseuniform.com

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CPT 2018 Changes for Orthopaedic Surgery

CPT 2018 Changes for Orthopaedic Surgery: It’s all about that Spine……almost

By Heidi Stout, CPC, COSC, CCS-P

 

Not much will change for orthopaedic surgery coding in 2018.  Most of the changes in CPT 2018 to the Musculoskeletal System codes (20005-29999) and Nervous System- Spine And Spinal Cord codes from 2017, including additions, deletions, and revisions, impact the reporting of orthopaedic spinal procedures.  Only one new code has been added and two have been deleted.  A number of instructional notes have been added to clarify proper reporting of certain codes.

Here are the noteworthy changes:

CPT code 20225-Biopsy, bone, trocar, or needle; deep (eg, vertebral body, femur)

  • A new instruction note has been added: “For bone marrow biopsy(ies) and/or aspiration(s), see 38220, 38221, 28222”.

Injection or Removal (CPT codes 20500-20664)

  • A new instructional note has been added: “For injection of autologous adipose-derived regenerative cells, see 0489T, 0490T”.

Grafts (or Implants) (CPT codes 20900-20939)

  • A new instructional note has been added: “Codes for obtaining autogenous bone, cartilage, tendon, fascia lata grafts, bone marrow, or other tissues through separate skin/fascial incision should be reported separately, unless the code descriptor references the harvesting of the graft or implant (eg, includes obtaining graft)”.

CPT code 20926- Tissue grafts, other (eg, paratenon, fat, dermis)

  • New instructional notes have been added: “Do not report code 20692 in conjunction with 0489T, 0490T”, “For harvesting of adipose tissue for autologous adipose-derived regenerative cell therapy, see 0489T, 0490T”, “For injection of autologous adipose-derived regenerative cells, see 0489T, 0490T”, “For harvesting, preparation, and injection(s) of platelet-rich plasma, use 0232T”.

 

CPT code 20938- Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition to code for primary procedure)

  • A new instructional note has been added: “For bone marrow aspiration for bone grafting, spine surgery only, use 20939”.

 

New CPT code 20939 has been added with instructional notes

  • 20939- Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision (List separately in addition to code for primary procedure)
  • “Use 20939 in conjunction with 22319, 22532, 22533, 22534, 22548, 22551, 22552, 22554, 22556, 22558, 22590, 22595, 22600, 22610, 22612, 22630, 22633, 22634, 22800, 22802, 22804, 22808, 22810, 22812”
  • “For bilateral procedure, use 20939 with modifier 50”
  • “For aspiration of bone marrow for the purpose of bone grafting, other than spine surgery and other therapeutic musculoskeletal applications, use 20999”
  • “For bone marrow aspiration(s) for platelet-rich stem cell injection, use 0232T”
  • “For diagnostic bone marrow aspiration(s), see 38220, 38222”

 

Application of Casts and Strapping

  • A new instructional note has been added: “For orthotics management and training, see 97760, 97761, 97763”

CPT code 29540-Strapping; ankle and/or foot

  • An instructional note has been revised: “Do not report code 29540 in conjunction with 29581”

CPT code 29580- Strapping; Unna boot

  • An instructional note has been revised: “Do not report code 29580 in conjunction with 29581”

CPT code 29581- Application of multi-layer compression system; leg (below knee), including ankle and foot        

  • An instructional note has been revised: “Do not report code 29581 in conjunction with 29540, 29580, 36468, 36470, 36471, 36475, 36476, 36478, 36479”

 

 

CPT codes 29582 and 29583 have been deleted

  • 29582- Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed
  • 29583- Application of multi-layer compression system; upper arm and forearm

Anterior or Anterolateral Approach for Extradural Exploration/Decompression

  • An instructional note has been added: “For vertebral corpectomy, the term partial is used to describe removal of a substantial portion of the body of the vertebra. In the cervical spine, the amount of bone removed is defined as at least one-half of the vertebral body.  In the thoracic and lumbar spine, the amount of bone removed is defined as at least one-third of the vertebral body.”

 

Lateral Extracavitary Approach for Extradural Exploration/Decompression

  • An instructional note has been added: “For vertebral corpectomy, the term partial is used to describe removal of a substantial portion of the body of the vertebra. In the cervical spine, the amount of bone removed is defined as at least one-half of the vertebral body.  In the thoracic and lumbar spine, the amount of bone removed is defined as at least one-third of the vertebral body.”

Excision, Anterior or Anterolateral Approach, Intraspinal Lesion

  • An instructional note has been added: “For vertebral corpectomy, the term partial is used to describe removal of a substantial portion of the body of the vertebra. In the cervical spine, the amount of bone removed is defined as at least one-half of the vertebral body.  In the thoracic and lumbar spine, the amount of bone removed is defined as at least one-third of the vertebral body.”

 

 

 

 

 

 

 

 

 

 

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CPT or I10-PCS for inpt surgery?

I’m wondering if my urology practice should be using I10-PCS procedure codes instead of CPT when they are doing a surgery over at the hospital and the patient is in an inpatient status? Or the CPT procedure codes b/c we are a clinic and our Dr’s NPI numbers are connected to the clinic-they are not employees of the hospital.

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