Please help!! For 2024, can 11970 & 19370 both be reported for same breast. I read all the guidelines & articles but honest, the way some of them are worded I get confused ..read more

My surgeon wants to bill 22901,15734, and 49560 (I know this is a deleted code) for the following documentation: The previous transverse incision had a widened unstable scar which was marked. An elliptical incision 8 x 5 cm, was made with # 10 blade and then carried down to the fascia with electrocautery. Single skin hooks are placed in the neo-umbilicus and an 11 blade is used to incise circumferentially around the umbilicus using the old scar. Sharp dissection is used to bevel away... Click to expand... Read more ..read more

Hello all- Has anyone found a way to bill for scar revision? Since we can no longer use the complex repair codes we are at a loss as to what to use. Cannot use the lesion removal codes since there is a LCD for that and L90.5 is not on that list. I am meeting with my provider this afternoon to discuss this as he wants "to get paid for what he does and some are extensive". I totally agree with this but don't know what to tell him. Thank you for any and all input. Deb ..read more

My provider wants to submit 15733 for the named muscle flaps listed in the statement below. I know the semispinalis & splenius capitis are in the neck area but I am leaning more towards 15734 only because the description of 15733 states neck but list only the anterior muscles (buccinators, genioglossus, temporalis, masseter, sternocleidomastoid, levator scapulae) as examples. Would appreciate some opinions please! "posterior cervical muscle flaps were therefore performed to allow for... Read more ..read more

I'm hoping someone can give me a little direction here. Patient with work degloving injury to left hand. Main procedure is Radial artery perforator adipofascial flap. The surgeon is doing this exact procedure: https://www.oaepublish.com/articles/2347-9264.2020.20. The surgeon is performing additional procedures such as nerve and tendon repairs and a Split Thickness graft which would be coded separately. We are just having an issue of finding the exact code for this adipofascial... Read more ..read more

CPT Code 19318 Medicare in Alabama's LCD only has one primary diagnosis (Macromastia) for breast reduction post mastectomy for symmetry. Not EVERY patient has that as a primary diagnosis. Other carriers have "Cancer" diagnoses as covered when listed as primary. I have contacted our Carrier and they "insinuate" that the 19318 code is incorrect, of course they will not tell me why. Anyone else with the same issue ..read more

Any thoughts? The patient saw the plastic surgeon in the past three years and had cosmetic surgery that was not billed to the insurance. The patient then returns for a medical issue and an office visit is billed. Would you code as a new patient or established ..read more

Hello, What documentation is everyone looking for to support intermediate repair on the face/scalp? I recently had a discussion with one of my surgeons and they were questioning the subq repair in the face/scalp given some areas have little/no subq. They often do wide undermining in these areas in addition to the layered closure. How would anyone meet the subq requirement in these areas given that some have little/no subq? If that makes sense. How do we ensure they are documenting correctly... Read more ..read more

Hello everyone, I have a surgeon emailing regarding coding that was done, and I want to have documentation/literature of the correct coding for some things before I reply. fasciocutaneous flaps (15733-15738); in almost every single surgery, my providers "suggest" bilateral fasciocutaneous flaps, and the documentation looks something like this: We continued on to elevate bilateral fasciocutaneous advancement flaps with the Bovie measuring 3 x 2 cm each. Both flaps were then... Click to expand... Read more ..read more

Good morning, I have been researching this and cannot find a definitive answer. Any thoughts are greatly appreciated. My surgeon performed gynecomastia reduction surgery and free nipple grafting. She documented it differently this time (as skin graft) and am wondering if it will bundle into main surgery or if can capture it with skin graft codes - if not graft code possibly -22. I have my 19300 and 15877 codes that we normally bill for gynecomastia but not sure about the nipple grafts... Read more ..read more