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Coding Corner: Billing for Emergency Surgery | Andrew Menzin, MD, MBA, FACOG, FACS

Andrew Menzin, MD, MBA, FACOG, FACS

Scenario: My patient with a history of ovarian cancer came to the emergency department (ED) with abdominal pain and was found to have a bowel perforation. I took her to the operating room for a diverting colostomy. Can I bill for ED evaluation?

Yes. Billing for this scenario includes two elements: (1) the ED evaluation during which the determination is made to confirm a large bowel perforation and make a decision to urgently proceed with exploration, and (2) the operative procedure. For the ED evaluation, the diagnosis codes of C56.9 (ovarian cancer) and K63.1 (large bowel perforation) should be selected and linked with an E/M service of initial hospital care (99221, 2, or 3), depending on the complexity of the service or based on the time required for the evaluation.

The Decision for Surgery modifier (-57) should be appended to the E/M service code because the E/M service and the procedure were performed within 24 hours. As to the procedure itself, if a partial resection (of the perforated area) in conjunction with an end colostomy and closure of the distal segment (Hartmann procedure) was performed, the CPT code 44143 should be used.

Andrew Menzin, MD, MBA, FACOG, FACS, is a gynecologic oncologist at Northwell Health in Manhasset, NY.

Coding and Reimbursement Q&A by Category

Disclaimer: Answers to incoming questions are provided by the members of the SGO Coding and Reimbursement subcommittee and represent their opinion based upon the current and usual practices in the field. Every effort is made to ensure the accuracy of the information provided. However, the information neither replaces information in Medicare regulations, the CPT-4 code book, or the ICD-10 CM code book; nor does it constitute legal advice. Responses to questions are intended only as a guide and are not a substitute for specific accounting or legal opinions. SGO expressly disclaims all responsibility and liability arising from use of, or reliance upon this information as a reference source, and assumes no responsibility or liability for any claims that may result directly or indirectly from use of this information, including, but not limited to, claims of Medicare or insurance fraud.

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Ask a Coding Question

SGO Coding and Reimbursement subcommittee members are happy to answer your coding questions, but are unable to review individual operative reports.

If you have a coding question, please reference the updated Coding and Reimbursement Q&A by Category resource. If you do not find your answer in the coding Q&A library, please send your coding question to coding@sgo.org.

Answers to incoming questions are provided by the members of the SGO Coding and Reimbursement subcommittee and represent their opinion based upon the current and usual practices in the field. Every effort is made to ensure the accuracy of the information provided; however, the information neither replaces information in Medicare regulations, the CPT-4 code book, or the ICD-10 CM code book; nor does it constitute legal advice. Responses to questions are intended only as a guide and are not a substitute for specific accounting or legal opinions.

SGO expressly disclaims all responsibility and liability arising from use of, or reliance upon this information as a reference source, and assumes no responsibility or liability for any claims that may result directly or indirectly from use of this information, including, but not limited to, claims of Medicare or insurance fraud.

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