Another week has flown by, and this week was full of coding subtlety. I had the opportunity to work with a coder who has around 20 years of experience in OB/GYN coding and we were able to share our ideas and thoughts...
First up, we discussed the usage of modifier 22 and 59 in the coding scenario below. We were presented with a well documented case, and probably 5 coders all looked at it, and came up with different answers. However, in the end we all came to consensus...
In this scenario, the provider documented a Lap assist vag hysterectomy w/extensive adhesiolysis, and a monarch sling repair.... Initially, it looked very straightforward but we thought we might add a mod 22 to the lap assist vag hyst to cover the extensive adhesiolysis.
however, as we dug deeper into the actual verbiage of the case... the adhesiolysis was performed laparoscopically, then the case was converted over to a straightforward vaginal hysterectomy, and a monarch bladder sling....
Learning lesson... Always dig deeper, and ask the opinion of other coders around you!!! WOW what a great learning moment.
Then I got to work with a physician on improving his documentation for the E&M Discharge code 99238 and 99239... I reviewed the requirements for billing the 99238... CPT has clarified what has to be documented fodr the 99238. No longer can you simply state that you discharged the patient to home.... Again.. another situation where I got to witness an "a-ha, I get it now" moment.
And to finish up the week, one of my favorite neurosurgery coders sent me an op to look at as she wasn't sure she was on the right track.... In this scenario, the provider was performing a nerve decompression, but the operative note read nearly like a neuroplasty... It was an amazing case to review, and I am so glad that she shared it with me!
So... as for the "coding coach" part of this weeks blog... I guess all I can say is, take the time and really read and review your operative notes, and if you're unsure... Spread the love, and ask the opinion of other coders around you! It's amazing what you both can learn from each other!
Keep Learning, Keep Coding, and have fun!!!!
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