Tag: Articles

In our last article, we discussed how to code percutaneous procedures in arteriovenous (AV) fistulas and grafts. If you haven’t had a chance to read part 1 of this article, I encourage you to do so first to gain the most benefit from the information below: AV Fistula and Grafts Part 1.

Today, we are going to take a look at procedures that are performed in AV fistulas and grafts through an open approach. We will also look at hybrid procedures (cases where part of the procedure is performed through an open approach and part through a percutaneous approach). These procedures present unique challenges due to guidelines that bundle some of the percutaneous procedure codes to the open procedure codes – more on that in a moment. Continue reading “AV Fistula and Graft Procedures Part 2” →

A ventricular assist device (also referred to as a VAD) is a mechanical device that assists the heart when the heart is too weak to adequately circulate blood to the body.  These devices may be used to temporarily support a patient whose heart is failing due to injury or illness. They are also sometimes used to help support a patient’s failing heart until the patient can have a heart transplant (in notes the physician may refer to this as a “bridge to transplant”).

The ventricles of the heart are the natural “pumps” in the heart.  The right ventricle pumps blood through the pulmonary artery and into the lungs to receive a fresh supply of oxygen while the left ventricle pumps blood out of the heart and into the aorta where it can circulate to the rest of the body.  When one of the heart’s natural pumps fail, this can cause serious health problems and even death if left untreated.

A VAD can be placed to support the left ventricle, the right ventricle, or both.  A VAD placed to support the left ventricle is sometimes referred to as an LVAD for short while a VAD placed to support the right ventricle is sometimes referred to as an RVAD for short.  A VAD placed to support both ventricles of the heart is sometimes referred to as a biventricular VAD or a BIVAD for short. Continue reading “Ventricular Assist Devices” →

One aspect of coding that even seasoned coders can struggle with is communicating with physicians. Sometimes coders need to inform a physician that the information contained in his or her note lacks a detail that the coder requires to choose the correct code.  Other times, coders need to tell a physician that a code that he or she has suggested be billed cannot be reported due to a rule the physician may not be aware of. These messages can be difficult to deliver, but there are some steps that we as coders can take to help the physician understand the information we are providing and in turn give us what we need to get the job done. Continue reading “The “Soft Skills” of Coding” →

When a patient has a mastectomy, the next step in their journey is often reconstruction of the breast. There are many different methods to reconstructing the breast. One method involves the placement of a tissue expander. A tissue expander is a small inflatable prosthesis that is implanted into the cavity left after the mastectomy surgery. The expander is typically placed at the same time as the mastectomy surgery but in some cases may be placed later on. After placing the expander, saline is then injected into the tissue expander slowly over time which causes the expander to enlarge and in turn causes the skin to stretch.  Once the skin has stretched enough to allow placement of a breast implant, the tissue expander is removed and replaced with a permanent breast implant.

This article is dedicated to coding that second step of the procedure where the tissue expander is removed and a permanent breast implant is placed. There are two CPT codes to consider for this operation. CPT 11970 is for a routine removal of a tissue expander with insertion of a permanent breast implant, also known as a breast prosthesis. This code includes removal of the expander, measuring/sizing the mastectomy cavity to pick the correct implant for the patient, minor adjustments to the breast capsule to allow the implant to sit right, and inserting the implant itself.

Our other option for this surgery is CPT 19342. This code can be used for a more complicated tissue expander removal and breast implant insertion. The AMA has recommended using CPT 19342 when the procedure requires “significant capsular adjustments” to allow the breast implant to sit correctly.  The AMA goes on to provide a couple of examples of adjustments that would support significant capsular adjustments including a radial capsulotomy, a partial or total capsulectomy, or raising/lowering the inframammary crease. When these procedures are performed to allow placement of a breast implant, they are not reported with separate CPT codes, but are considered included in CPT 19342.

When someone says chest tube insertion, most coders immediately think of CPT 32551 as the code to represent this procedure. While CPT 32551 is certainly one valid code for a chest tube insertion into the pleura, it is not the only code that can describe this procedure. To ensure we select the correct CPT code, the main key we need to look for in the procedure report is the  approach to the procedure. A chest tube may be inserted through an open approach or a percutaneous approach. Continue reading “Chest Tubes” →

A fusion of the vertebrae, which is also known as an arthrodesis procedure, is a procedure performed to cause a part of two or more vertebrae to “fuse” together over time. The procedure involves placing bone graft between the parts of the vertebrae the physician wants to fuse together. The goal of the procedure is to prevent movement of vertebrae which are causing the patient pain and also helps to stabilize the spine when it has been compromised by disease. Some common diseases that impact the spine include but are not limited to degenerative disk disease, spondylosis, and spondylolisthesis.

Fusions are first classified as either anterior fusions where the surgeon makes an incision from the front of the body and works his way down to the spine or as posterior where the surgeon makes an incision from the back of the body and works his way down to the spine that way. For posterior fusions, we then have some more options – the fusion can be posterior/posterolateral only, interbody, or combined. When an operative report directly tells us what type of fusion is performed, it can be straightforward to line up the term posterior, interbody, or combined fusion to the code descriptions in the CPT manual. But what happens when the surgeon doesn’t use one of these terms? Are we unable to code the procedure without getting additional information from the physician? Fortunately for us coders, there are some keys we can look for to help us determine the type of fusion performed. Continue reading “Interbody, Posterior, and Combined Fusions” →