Surgery News - March 2008 - (Page 13) MARCH 2008 • SURGERY NEWS NEWS BY ALBERT BOTHE JR., M . D. , FA C S , A N D DEBRA MARIANI, CPC FROM If I make one incision to repair two or more hernias, may I code for multiple hernia repairs? Medicare will pay for only one hernia repair per incision. If the surgeon believes the hernia repair was unusually complex and added significantly to the overall procedure, then modifier –22, “unusual procedural service,” can be appended to the code. Documentation explaining the unusual circumstance should be added to the claim. Has there been a code developed for laparoscopic hernia repair that is newer than code 49659? The unlisted procedure code 49659 is the correct code for Medicare. If this is a non-Medicare patient, you might check with your insurer to see if it has an alternative preferred code. What is the correct way to code for a repair of parastomal hernia and ventral hernia repair with mesh? If the surgeon did a revision of the colostomy with repair of a paracolostomy hernia, then use code 44346. If two separate and distinct hernias were repaired (such as parastomal and ventral), then it is appropriate to also report code 49560 with a multiple procedure modifier –51. If mesh was used for the ventral hernia repair, use 49568 as an add-on code. How does one code for the mesh when billing an umbilical hernia repair with THE COLLEGE same claim form that you bill the original procedure. If VTE prophylaxis was ordered or administered according to the measure, then you report the code 4044F. If it was not ordered or administered for a medical reason, then you report 4044F-1P. If it was not ordered or administered and there is no documented reason, then report 4044F-8P More information on measures and codes, frequently asked questions, flow sheets, and a sample claim form are available at www.facs.org/ahp/pqri/ claimexample.pdf, or visit www.cms. hhs.gov/PQRI, the Centers for Medicare & Medicaid Services Web site. ■ *All specific references to CPT terminology and phraseology are © 2007 American Medical Association. All rights reserved. Resources National Correct Coding Initiative www.cms.hhs.gov/NationalCorrect CodInitEd/NCCIEP/list.asp#Top OfPage Medicare Correct Coding Guide Salt Lake City, UT: Ingenix; 2007 (ISBN 1-978-56337-949-9) Dr. Bothe is chief quality officer, Geisinger Health System, Danville, Pa. Ms. Mariani is practice affairs associate, Division of Advocacy and Health Policy, ACS. Call ACS Coding Hotline to Answer Hernia Questions T his column lists some questions regarding Current Procedural Terminology (CPT)* posed to the ACS Coding Hotline and the responses. ACS members and their staff may consult the hotline 10 times annually without charge as a membership benefit. If you have coding questions, contact the Coding Hotline at 1-800227-7911 between 8:00 a.m. and 6:00 p.m. central time, holidays excluded. A surgeon performed the following: 44160, colectomy, partial, with removal of terminal ileum with ileocolostomy; 49560, repair initial incisional or ventral hernia; reducible; 49568 (add-on code), implantation of mesh or other prosthesis for incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection; and 44005, enterolysis. Why was only the claim for 44160 approved? The National Correct Coding Initiative (NCCI) edits allow reporting of the three codes (with a modifier); however, if the hernia repair is performed at the site of an incision for an open abdominal procedure, the hernia repair is not separately reportable. The mesh code 49568 is an add-on code for hernia repair. According to the NCCI edits, the enterolysis (44005) is considered an integral component of the colectomy code. mesh? Can the add-on code of 49568 still be used? No, this add-on code is only for incisional or ventral hernia. With the exception of incisional and ventral hernias (49560 and 49566), use of mesh is not separately reportable. The surgeon performed an inguinal hernia repair (49505, repair initial inguinal hernia, age 5 years or older; reducible) and billed and is getting paid for the add-on code of 49568, implantation of mesh or other prosthesis for incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection along with 49505. Can he continue to bill for the mesh placement? This setup is incorrect billing of 49568. The add-on code of 49568 is for incisional and/or ventral hernia repairs only. Medicare rules indicate that mesh placement is inclusive to all other types of abdominal hernia repairs. When reporting on the flow sheet required for participating in the Physician Quality Reporting Initiative (PQRI), should we use the modifiers next to the CPT code 49560? What PQRI code do I use? Do I use the “F” code, and which modifier should I use, “p1” or “p8”? The only measure that applies to CPT code 49560 is number 23, ordering and administering venous thromboembolism (VTE) prophylaxis. To report this measure, you must use the appropriate CPT II or “F” code on the NTDB Cites Age-Related Injury Trends B Y R I C H A R D J. FA N T U S , M . D. , FA C S your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at mneal@facs.org. ■ Dr. Fantus is director, trauma services, and chief, section of surgical critical care, Advocate Illinois Masonic Medical Center; clinical professor of surgery at the University of Illinois; and chair of the ad hoc Trauma Registry Advisory Committee of the Committee on Trauma. hat happens when one reaches his or her 60th year? Many people start to experience the physiologic effects of aging: loss of taste and smell, and loss of balance and coordination that will leave them prone to falls and injuries. To examine the occurrence of age-related injuries in the National Trauma Data Bank® Dataset 7.0, all records for patients aged 60-69 years were identified, and 102,387 records with discharge status were found. Of these patients, 65,428 were discharged to home, 20,052 to acute care/rehabilitation, and 10,991 to nursing homes; 5,916 died. Victims were 57% male and on average 64.2 years of age; there was an average length of hospital stay of 6.9 days, an intensive care unit stay of 2.8 days, and an average injury severity score of 10.9. Of those tested for alcohol, 16% were positive. Although motor vehicle–related injuries accounted for a similar overall percentage, falls were 1.6 times more frequent in this age group when compared with data in the overall 2007 report. Lifestyle modifications can help promote a long, healthy, and fulfilling life. Cardiovascular exercise, stretching, and core exercises are key, along with challenging your brain by learning new skills. With improved cognition and regained balance, you are less likely to be injured and more likely to become 60-something. The full NTDB Annual Report Version 7.0 is available on the ACS Web site at www.ntdb.org. To submit W Surgeons Diversified Investment Fund Lowers Expense Ratio n an effort to offer ACS members and affiliated organizations a reasonably priced investment product, the expense ratio of the College’s Surgeons Diversified Investment Fund (SDIF) has dropped to just over 1%. Effective Feb. 8, 2008, the lower expense ratio will have an immediate positive impact on current shareholders. Over time, it will positively impact the performance returns for prospective and current shareholders. The new expense ratio, including ETF costs, is 1.08%. Moving forward, all current and prospective investors will be able to invest at a lower cost in a no-load, open-end, diversified, actively managed mutual fund broadly modeled after the ACS’s endowment utilizing the investing principles of asset allocation, diversification, and rebalancing. You may download the prospectus at www.surgeonsfund.com or call 1-800-208-6070 to request a copy. An investor should consider the charges, risks, expenses, and investment objective carefully before investing. Read the prospectus carefully before you invest or send money. SDIF is distributed by Ultimus Fund Distributors, LLC, 225 Pictoria Dr., Suite 450, Cincinnati, OH 45246; 513-587-3400. ■ I Hospital Discharge Status of Patients Aged 60-69 Years 11% Nursing home 6% Death 20% Acute care/ rehabilitation Note: Percentages do not equal 100% because of rounding, based on 102,387 records from 2002 to 2006. Source: National Trauma Data Bank Dataset 7.0 ELSEVIER GLOBAL MEDICAL NEWS 64% Home http://www.facs.org/ahp/pqri/claimexample.pdf http://www.facs.org/ahp/pqri/claimexample.pdf http://www.cms.hhs.gov/PQRI http://www.cms.hhs.gov/PQRI http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp#TopOfPage http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp#TopOfPage http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp#TopOfPage http://www.surgeonsfund.com http://www.ntdb.org
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