Learning How to Use CPT Modifiers on UB-92 Claims

Learning How to Use CPT Modifiers on UB-92 Claims


Learning How to Use CPT Modifiers on UB-92 Claims

Kim Charland

As explained in the Coding Corner column that appeared in the Sept. 29, 1997, issue of ADVANCE for Health Information Professionals, now is the time for hospital coders to start learning how to use CPT modifiers when billing the technical component of outpatient services. At the present time, early April 1998 is when this new requirement will take effect.

The two examples below may give readers a better understanding of CPT modifier assignment.

Case Study 1

Preoperative Diagnosis: Hallux valgus deformity, right foot with large bunion

Postoperative Diagnosis: Hallux valgus deformity, right foot with large bunion

Procedure: Silver bunionectomy, right hallux and first metatarsal

Technique: The patient was brought to the operating room after being correctly identified, placed on the operating table in the supine position and given general anesthetic per protocol. A pneumatic tourniquet was placed high on the right thigh; the leg was prepped and draped in sterile fashion. After elevation for five minutes, the tourniquet was inflated to 300 mmHg.

A longitude dorsal medial incision was made directly centered over the bunion. Using sharp and blunt dissection, the superficial saphenous nerve was identified and protected. The capsule was split longitudinally exposing the underlying bunion. A small portion of the capsule was removed as part of the capsulectomy.

Once the bunion was exposed, it was removed with a sharp osteotome and mallet. Bone rasps and bone wax were used to smooth the donor surface. Bone wax was placed on the donor bed. There were no sharp protrusions to digital palpation.

The wound was irrigated with Bacitracin-permeated normal saline solution. An undyed Vicryl stitch was used to close the capsule in an interrupted and running fashion. Subcutaneous tissue was closed with 4-0 Vicryl stitches protecting the superficial nerve. The skin was closed with 4-0 nylon.

On the lateral side of the toe, the incision was closed after irrigation with 4-0 nylon stitch in a running fashion. A sterile bulky dressing was placed. The patient was taken to the recovery room in stable condition without sequelae.

Code Assignment

ICD-9-CM Diagnosis Codes

735.0 Hallux valgus

727.1 Bunion

ICD-9-CM Procedure Codes

77.59 Other bunionectomy

CPT Procedure Code and Modifier

28290-T5 Hallux valgus (bunion) correction, with or without sesa-moidectomy; simple exostectomy (Silver type procedure)/Right foot, great toe

Case Study 2

Preoperative Diagnosis: Right inguinal hernia

Postoperative Diagnosis: Right direct inguinal hernia, skin lesion (keratosis)

Procedure: Repair of direct inguinal hernia with Tanner slide

Technique: Under endotracheal general anesthesia and supine on the operating table, the patient was given 1 gram of Ancef IV. His right lower quadrant and abdomen were prepped and draped in the usual fashion. There was a small 1 cm x 5 mm lesion in the way of the incision, and this will be removed with the incision.

An incision was made in that area encompassing the lesion as well, and this was sent to pathology. The vessels were clamped and tied. The fascia was identified and opened. The ileoinguinal nerve was mobilized up and moved to a position of safety.

There was a large bulge in the area. Mobilizing off the pubic; I got the cord contents and saw that this was largely a direct hernia. I freed the cord contents right back to the internal opening, and there was no appreciable sac present.

The posterior wall was brought right out, and there was a large amount of fatty tissue. This was mobilized and pushed back down into the abdomen. The first layer was imbricated using 2-0 Vicryl in a continuous suture, bringing this layer down.

The repair was then brought together, bringing the conjoined tendon down to the ileoinguinal ligament using 2-0 Ethibond and interrupted sutures.

The repair was quite solid. The internal opening admitted an instrument quite easily. The nerve and artery were in good position. The epigastric vessels had been previously seen. A Tanner relaxing incision was done in the anterior fascia. The inguinal nerve was put back. The external ring was reapproximated by bringing the inguinal ligament back together using 2-0 Ethibond.

Hemostasis was achieved by cautery. The dead space was obliterated with 2-0 Ethibond and 2-0 Vicryl for skin. Steri-strips were applied. The patient tolerated the procedure well, was awoke and extubated and taken to the recovery room in good condition. The testicle was in the sac at the end of the case.

Code Assignment

ICD-9-CM Diagnosis Codes

550.90 Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified

702.19 Other seborrheic keratosis

ICD-9-CM Procedure Codes

53.01 Repair of direct inguinal hernia

86.3 Other local excision or destruction of lesion or tissue of skin and subcutaneous tissue

CPT Procedure Codes

49505-RT Repair initial inguinal hernia, age 5 years or over; reduci-ble/Right side

11401-59 Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm/Distinct procedural service

* About the author: Kim Charland, a senior health care consultant with Medical Learning Inc. (MedLearn), St. Paul, MN, has more than 10 years of experience in health information management. Her areas of expertise include ICD-9-CM and CPT coding for hospital ambulatory surgery, emergency department and anesthesia services, as well as physician services.