We would try to. Check out the box to the left to see the reim-bursement you can expect these new codes to bring in. Another plus: Having assigned codes will also help with the time you spend preparing a claim and also reduce the time it takes payers to reimburse you for these procedures. Whenever you submit an unlisted code you must also send along the operative report, a letter explaining the procedure the surgeon performed, comparing the procedure to another. You won't have to do this extra work thanks to the new codes.
Not having to submit documentation will be an extra benefit of the new codes. Bonus: When you were coding with unlisted codes, you had to send in documentation and wait for the payer to review your claim, delaying your payment. As the descriptors of the new hernia repair codes indicate, these procedures include mesh insertion and you cannot separately code for the mesh, much to the dismay of coders. Pay attention: "Mesh coding remains a stumbling block for many coders new to general surgery," Tweed says.
As long as the coder reads the entire description, they should not have a problem. They will not try to somehow add mesh on either by using the unlisted code or incorrectly using the mesh code for open. You've reached your maximum viewable free articles. Subscribe today to continue reading this article and you'll get:. General Surgery Coding Alert. Published on Thu Nov 27, With no specific code to describe the procedure, you-re forced to submit an unlisted code, which means extra documentation work for you, a slower turnaround time on your claim, and a reimbursement guessing game.
Here's what you need to know to get the most out of these new codes as soon as they take effect on Jan. Get to Know the New Codes In addition to the two laparoscopic repair codes for inguinal hernias , Laparoscopy, surgical; repair initial inguinal hernia and , The codes are differentiated by the type of hernia the surgeon fixes, as follows: -- Laparoscopy, surgical, repair, ventral, umbilical, spigelian, or epigastric hernia includes mesh insertion, when performed ; reducible -- Laparoscopy, surgical, repair, ventral, umbilical, spigelian, or epigastric hernia includes mesh insertion, when performed ; incarcerated or strangulated -- Laparoscopy, surgical, repair, incisional hernia includes mesh insertion, when performed ; reducible -- Laparoscopy, surgical, repair, incisional hernia includes mesh insertion, when performed ; incarcerated or strangulated -- Laparoscopy, surgical, repair, recurrent incisional hernia includes mesh insertion, when performed ; reducible -- Laparoscopy, surgical, repair, recurrent incisional hernia includes mesh insertion, when performed ; incarcerated or strangulated.
Don't Lean on the Unlisted Code Anymore Old way: Before CPT added these codes, you had to use unlisted lap code Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy for all lap hernia repairs, except initial inguinal and recurrent inguinal, Tweed explains.
Another plus: The time you-re counting for these prolonged services does not have to be continuous either. You should code the level of care based on medical necessity and time. This visit would be eligible for an additional prolonged service code of Prolonged physician service in the office or other outpatient setting requiring direct [face-to-face] patient contact beyond the usual service; first hour [List.
Remember that codes are time based and are add-on codes. You do not need to append a modifier to these codes and you. If you were one of the lucky few getting paid for , CPT will disappoint you.
Expect an easier time getting paid for prolonged services that your general surgeon provides face-to-face to a patient. Most payers recognize prolonged services codes for direct patient care, but not for indirect care, experts explain. Important: Most carriers, including Medicare, will not reimburse for prolonged physician service and without direct face-to-face patient contact.
You've reached your maximum viewable free articles. Subscribe today to continue reading this article and you'll get:. General Surgery Coding Alert. Published on Thu Nov 27, That means that physicians may be able to earn prolonged services for complex patients who require coordination with other providers, review of multiple tests and studies, or coordination of orders with monitoring throughout the day.
Get Acquainted With You should code the level of care based on medical necessity and time.
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