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Reader Questions: Count Cleaning With Laceration Repair Codes

Ask FI for Injection Help

Question: Our facility is having difficulty reporting codes Q0081 and 90784 together. Should we be appending modifier -59? I get the impression that 90784 is a component of Q0081, but it seems to me that an IV injection is a separate procedure from an IV infusion. 
 
Alabama Subscriber

Answer:  Effective Jan. 1, 2003, CMS created a mutually exclusive edit for the diagnostic injection code (90784) with the infusion therapy code (Q0081) and the chemotherapy administration codes (Q0083-Q0085), so you weren't allowed to bill them together. However, CMS has stated that it is continuing to research this issue based on obvious objections to this significant policy change in ambulatory payment classification (APC) reimbursement. You should contact your fiscal intermediary (FI) for further clarification. In some instances, modifier -59 (Distinct procedural service) may be appropriate.




Don't Forget Modifiers With Certain Revenue Codes

Question: Our facility has a wound care program run by a certified wound care nurse.  We were billing wound care charges to our fiscal intermediary (FI) for code 97601 with revenue code 940, but we got the claims back with a statement from the FI saying the CPT and/or revenue code isn't correct. Our FI suggested we try revenue code 960 or 421 instead, but neither of them received approval. How can we get reimbursed for these services?

 Oregon Subscriber

Answer: You can generally bill CPT code 97601 (Removal of devitalized tissue from wound[s]; selective debridement, without anesthesia, including topical application[s], wound assessment, and instruction[s] for ongoing care, per session) with any of the following revenue codes, subject to the approval of your FI:

  940 - Other therapeutic services
  510 - Clinic
  420 - Physical therapy, general
  421 - Physical therapy visit
  430 - Occupational therapy, general
  440 - Speech-language pathology, general.

The latter four require modifiers -GP (Services delivered under an outpatient physical therapy plan of care), -GO (Services delivered under an outpatient occupational therapy plan of care), or -GN (Services delivered under an outpatient speech language pathology plan of care) as appropriate when performed under a therapy plan of care.

Cleaning Extensive Debris Can Elevate Repair Codes

Question: A patient presented with a long laceration on her leg caused by a broken pane of glass, which the physician cleaned and closed with sutures. It was a single-layer closure of a 13.6-centimeter wound, but the physician spent 42 minutes cleaning a lot of glass out of the area before closing it. Is this a simple or an intermediate repair?
 
 Louisiana Subscriber
 
Answer: The extra work involved raises this procedure to intermediate status. Report the repair 12035 (Layer closure of wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 12.6 cm to 20.0 cm).
 
CPT 2004 states that a simple repair "requires simple one-layer closure," which accurately describes the closure in this situation. However, CPT also reports that "single-layer closure of heavily contaminated wounds that have required extensive cleaning or removal of particulate matter also constitutes intermediate repair."

You can use repair codes when the physician closes the wounds with sutures, staples or tissue adhesives. You can also use the codes if two or more of these closure methods are used in combination on the same injury.

If the physician uses adhesive strips with these closure methods, you should still report repair. When adhesive strips are the only closure method, choose the appropriate evaluation and management code to report the repair.

Keep the below descriptions in mind when coding for wound repair (definitions for each type of closure begin on page 54 of CPT 2004):
 
Simple repairs (codes 12001-12021) close superficial wounds, usually on the epidermis or dermis, with a simple, one-layer closure. You also use simple repair codes to report local anesthesia, chemical cauterization or electrocauterization.
 
Intermediate repairs (codes 12031-12057) close superficial wounds, but they also require layered closure of one or more of the deeper layers of subcutaneous tissue in addition to the skin closure. Also use this code to report single-layer closure of a heavily contaminated wound that requires extensive preclosure cleaning.
 
Complex repairs (codes 13100-13160) close wounds that need more than layered closure, such as scar revision, debridement, extensive undermining, etc. Before completing a complex repair, the doctor must either create a defect for repairs (for example, excision of a scar requiring complex repair) or debride complicated lacerations or avulsions. The complex repair definition does not include excision of benign or malignant lesions.

- Reader Questions reviewed by Sarah L. Goodman, MBA, CPC-H, CCP, president of SLG Inc. Consulting in Raleigh, N.C.