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.
Can the size of the mesh inserted ( 6cm circle mesh) be used to determine the size of the hernia defect?
Hi Kim! Unfortunately, no. The guidelines specify the hernia measurement must be performed “either in the transverse or craniocaudal dimension. The total length of the defect(s) corresponds to the maximum width or height of an oval drawn to encircle the outer perimeter of all repaired defects. If the defects are not contiguous and are separated by greater than or equal to 10 cm of intact fascia, total defect size is the sum of each defect measured individually.”
Hi, does that mean you would only take the measurement that is the larger size, for example if he says 8×3 hernia you would say that is only 8cm? this would not be added as in 8×3 is 11?
Hi Barbra,
We would not recommend always selecting the longest dimension noted in the documentation. CPT provides specific guidance regarding how the defect would be measured. Provider education may be necessary to ensure the documentation completely indicates the size of the hernia defect.
Hernia measurements are performed either in the transverse or craniocaudal dimension. The total length of the defect corresponds to the maximum width or height of an oval drawn to encircle the outer perimeter of all repaired defects. The CPT book includes illustrations under these codes on how to measure and report different types of defects. (see page 390 in the 2023 CPT Professional edition).
Thank you!
Jennifer,
In the webinar, the inpatient prolonged service code 99418 was given. In the AMA guidelines, 993×0 is given. Please help us understand which is appropriate to use.
I tried to copy/paste the AMA reference, but this platform would not allow adding any material. thank you; mt
Hi Marie,
The AMA used 993×0 as a placeholder before the code set was officially published. The code is 99418.