Clarification please. The description of CPT 11960 is "insertion of tissue expander(s)". The (s) usually means single or multiple expanders would still only bill the code once. However, the MUEs for this code is 2 which implies 1 or 2 can be billed. Which is correct? If my physician is placing 2 expanders in 2 different sites (different incisions) on same day, would I bill 11960, 2 units or can I only bill 11960 once?
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Tag Archives: tissue
Soft Tissue Biceps Tenodesis
Is there a specific code for soft tissue biceps tenodesis? Any research I’ve done points to 29828 or 23430 depending on the approach.
Medical Coding Tissue Transfer or Rearrangement
I often see incorrect medical coding for “flaps”, which were adjacent tissue transfers, 14000-14350. Coders do not always understand that you can only code for the closure of the primary and secondary defect, but not for each flap that is created. Surgeons may have to create multiple flaps to close a defect, but the multiple […]
AAPC Knowledge Center
Biopsy of soft tissue
Hi,
I have two cases that involve needle biopsies of soft tissue masses, charging for facility side. The coding pathway leads to codes listed under Excision titles in the CPT book where the parenthetical notes underneath state ( For needle biopsy of soft tissue, use 20206). Here are pertinent excerpts from both reports with the two choices for codes. I’d really appreciate other opinions as to which is correct. I’m tending to lean towards the 20206 in both cases because 20206 specified percutaneous needle while the other codes listed under Excision headings do not specify percutaneous needle. I was told by another coder who is strictly facility that in I-10 PCS coding a biopsy reads out as an excision when any tissue is taken for a diagnostic test.
I have two cases that involve needle biopsies of soft tissue masses, charging for facility side. The coding pathway leads to codes listed under Excision titles in the CPT book where the parenthetical notes underneath state ( For needle biopsy of soft tissue, use 20206). Here are pertinent excerpts from both reports with the two choices for codes. I’d really appreciate other opinions as to which is correct. I’m tending to lean towards the 20206 in both cases because 20206 specified percutaneous needle while the other codes listed under Excision headings do not specify percutaneous needle. I was told by another coder who is strictly facility that in I-10 PCS coding a biopsy reads out as an excision when any tissue is taken for a diagnostic test.
Case 1:
Under CT guidance, a 19-gauge guide needle was advanced into the soft tissue mass adjacent to the colonic anastomosis. A 25-guage Chiba needle was inserted coaxially through the guide needle and a FNA was obtained. The sample was submitted to the on-site cytopathologist on slides and in formalin. The on-site cytopathologist reviewed the samples and determined that abnormal cells were seen. Then, at the request of the on-site cytopathologist, a 20 gauge core biopsy gun was inserted coaxially through the guide needle and a 20 gauge core biopsy sample was obtained which yielded scant material.
The two choices for this case are 10022, 20206 or 10022, 27041
Case 2:
Patient came today to the IR service for ultrasound guided biopsy of the left popliteal space subcutaneous soft tissue palpable nodule. The left popliteal fossa was prepped and draped in usual sterile fashion. (4) core biopsies were obtained using an 18 gauge Temno core biopsy needle within a coaxial system. The biopsy tissue was placed in formalin and sent tot he lab for cytopathologic evaluation.
The two choices for this case are 27323 or 20206
Thanks very much in advance!
Soft Tissue Radionecrosis
I know we don’t code to get paid. But, I go around and around with coding Soft tissue Radionecrosis. I code for a Wound Clinic. If I code as L59.8, the HBO gets paid but the debridement is denied for medical necessity. L59.8 isn’t listed on the LCD for debridements. I just need advise, to code correctly. If I start at necrosis and look for radiation, it states to see Necrosis by site. There is no soft tissue, but there’s subcutaneous newborn. Skin or subcutaneous states I96. So, then I confirm in the tabular section to find, I96 = Gangrene. So now, I’m confused. The note doesn’t mention Gangrene. If I start with Radiation, Sickness then the tabular states excludes radiation related disorder of the skin and subcutaneous tissue. So, now I’m back to L59.8. Please help!
Tissue Expander billing question
Is it appropriate facilities to be billing L8699 for tissue expanders with code 1935750? 19357 – Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion. Would that include the tissue expander or how should the implant be billed from the facility? Thank you
Radiation Proctitis vs. Soft Tissue Radionecrosis
I have a physician that is ordering Hyperbaric Oxygen Therapy for a patient with documented radiation proctitis. He is arguing that radiation proctitis is the same thing as soft tissue radionecrosis, and he is wanting to bill with L59.8 (specified disorder of skin and subcutaneous tissues related to radiation) instead of K62.7 (radiation proctitis). I understand that L59.8 is payable for HBOT, but I’m having trouble finding anything to support whether or not this is an accurate diagnosis for what is actually happening with the patient. We are under the NGS MAC. Can anyone offer any resources or advice? Thank you.
Adjacent tissue transfer for surgical closure?
My surgeon wants me to report an adjacent tissue transfer for closure of surgical wound for a hammertoe repair. I think this is incorrect and that surgical closure wound be included in the global package. Please provide some guidance. Thank you!!!
Q&A: Setting a price for corneal tissue
Q: I have a follow-up question to an answer you gave early last year. The question was about reimbursement for the cost of corneal tissue. You stated “This line item should reflect the costs associated with the corneal tissue.” We have just started providing this service and are having a debate on what this statement means. I think we can apply our usual markup, but our cost accounting person thinks this means we can only pass along our invoice cost. What does it mean in regard to setting our price?
A: In reviewing the original answer, this may have been confusing. The statement means that you should use the cost associated with the processing, preserving, and transporting of the tissue when you set your charge. Medicare pays this service based on reasonable cost basis, which means that it applies the cost-to-charge ratio to the line item in order to determine what your cost for the service was. The standard markup can be used, but you want to be sure you use only the cost related to the corneal tissue and nothing else on that line item. This will ensure not only that you receive appropriate reimbursement, but that you also report the correct cost to the Medicare program.
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Revant Solutions,in Fort Lauderdale, Florida, answered this question.
PLEASE HELP! Radiation soft tissue injury of the brain ICD-10 code(s)
I am having trouble determining the correct ICD-10 diagnosis code(s) for "Radiation soft tissue injury of the brain". One of my providers is treating a patient for this condition with hyperbaric oxygen therapy. He also refers to the condition as "Radiation therapy induced brain necrosis". I have done a lot of research and the choices seem to come down to L59.8- Other specified disorders of the skin and subcutaneous tissue related to radiation and a combination of I67.89- Other cerebrovascular disease and Y84.2-Radiological procedure and radiotherapy as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure. I do know that brain radionecrosis is considered a covered dx for hyperbaric treatment by some payers, but I67.89 and Y84.2 do not seem to be covered on the NCD. On the other hand, L59.8 is covered by the NCD, but I am not sure that diagnosis pertains to the brain. There is also T66.XXXA- Radiation sickness, unspecified, initial encounter, but that doesn’t seem specific enough and is also not covered by the NCD. I have been going in circles with this for a while now. Any and all help is VERY much appreciated. Thank you!!!
Angie Knight, CPC