Q: I just wanted to clarify that with the new hernia repair codes, if a patient has a reducible and a strangulated hernia repaired at once, both would be coded as strangulated hernias?
A: That is correct. The guidelines state the hernia repair would be coded as strangulated in that situation.
Q: In the nephrolithotomy codes, when 50080 is performed on one side and 50081 is performed on the contralateral side would modifier 50 be reported?
A: No, modifier 50 would not be reported for bilateral procedure. This is stated in the guidelines for these codes. Coders would report the 50080 and 50081 with the appropriate laterality modifier for left and right.
Q: When the parenthetical notes in CPT instruct the coder to use -52 modifier for reduced services, is this appropriate for facility coding?
A: Modifier -52 is used on the facility side for procedures that do not require anesthesia. When a procedure requires anesthesia, facility coders would report modifier 73 for discontinued outpatient hospital procedure prior to the administration of anesthesia and 74 for discontinued outpatient hospital procedure after the administration of anesthesia.
Added 3/15/23 - Q: On page 3 of the slide deck attached, I have the follow question on the new CPT codes for suture removal. On this topic for suture repairs, the presenter verbally stated how CMS defines ‘with anesthesia’ in CPT code descriptors. The speaker noted that for OPPS, CMS defines ‘anesthesia’ as “local, regional, general, or moderate sedation”. Could you send the supporting information regarding this definition from CMS? The Coding Clinic for HCPCS First Quarter 2012 pg 6 does not include local or moderate sedation as included in ‘requiring’ or ‘with anesthesia’.
A: You are correct regarding the Coding Clinic for HCPCS that states what qualifies as anesthesia for codes that require it. We were referencing the guidelines for anesthesia that applies to the use of modifiers 73/74 and not necessarily the CPT codes that state “requiring anesthesia.” That information is in the Medicare Claims Processing Manual 100-04, Chapter 4, section 20.6.4.
Jennifer Cayce, RHIT, CCS, CCS-P, CPC, AHIMA Approved ICD-10-CM/PCS Trainer
Director of Coding Quality & Compliance
As a Director of Coding Quality & Compliance, Jennifer brings over 20 years of health information management, auditing, and coding experience to Haugen Consulting Group.
During her career, Jennifer has served as an inpatient and outpatient medical coder, lead coder, coding supervisor, auditor, and has developed training materials for multiple areas of HIM. Jennifer was integral in the development of web-based HIM education for coders, providers, clinical documentation improvement specialists, case managers, and patient access professionals.
During her time as a coding supervisor, Jennifer experienced a high success rate when appealing RAC and other external audit findings.
At the Haugen Consulting Group, Jennifer coordinates and leads the facility audit team and provides coding expertise and support to clients.