I work with a plastic surgeon. He is supposed to do a surgery but is not in network with the patient's plan. The patient's plan might have OON benefits but to avoid all the complications of the NSA act and then the Insurance pays too little. He is going to do it as self pay and the patient has agreed to it. But the Hospital will bill the Insurance for the ancillaries. I just wanna make sure if the facility bills the Ins. then the doctor is supposed to bill the Ins. too? The patient can't... Read more ..read more

Quick question please on the use of modifier 62 for co-surgeons specifically as it relates to plastics.... if two plastic surgeons of the same specialty are performing a breast procedure simultaneously, one on the left breast and one on the right breast (same procedure) how is this coded? Would it be ... 1xxxx LT (surgeon one) 1xxxx RT (surgeon two) or 1xxxx 62 LT (surgeon one) 1xxxx 62 RT (surgeon two) The issue seems to be the definition of co-surgeons. The surgeons are under the... Read more ..read more

Can modifier 82 be used with the same specialty? I have a plastic surgeon who assisted another plastic surgeon (in the same group) with a vaginoplasty, bilateral orchiectomy, penectomy, urethroplasty, clitoroplasty, labiaplasty and perineoplasty. The note clearly states the assistant was needed due to no qualified resident ..read more

I have a physician who will do a fasciocutaneous advancement flap to reconstruct the lateral breast mound (15734) and then also insert pre-pectoral tissue expanders (19357) during the same surgical session. They do the fasciocutaenous flap due to the amount of dissection that was performed during the mastectomy the patient had, the dissection had exceeded the anatomic boundaries of the breast mound for adequate oncologice resection. I am getting an NCCI edit for the 15734 being inclusive... Read more ..read more

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