Surgical Notes Clients Ask Their Top Coding Questions

By Mandeara Frye, RHIA, CPC, CPMA, CASCC, Director of Coding

In this blog post, I'll answer some of the coding questions our clients have asked via The Note Pad, an online community Surgical Notes launched in 2016 exclusively for clients. The Note Pad is designed to engage, educate, and reward clients that use Surgical Notes’ solutions and services.

Dislocated Intraocular Lens

Q: What is the ICD-10 code for dislocated intraocular lens: H27.13x or T85.22XA?

A: The ICD-10-CM index is a great place to get clarification on this question. If we index "dislocation, lens," we’re provided multiple choices:

• Lens (complete) H27.10
  • Anterior H27.12
  • Congenital Q12.1
  • Ocular implant – see Complications, intraocular lens
  • Partial H27.11-
  • Posterior H27.13-
  • Traumatic S05.8X-

It’s important to start in the index to review your options and compare those to the patient’s medical record. Is it a dislocation of a previously placed intraocular lens? If so, then it would be coded as a complication (T85.22XA). Is it a dislocation of the patient’s natural lens, and if it is, is it due to trauma? In that case, we would look to S05.8X-. For nontraumatic dislocations of the natural lens, that leaves us with an anterior, congenital, partial, or posterior dislocation.

Toe Arthroplasty

Q: Is there any information on the horizon for coding toe arthroplasty? We must use an unlisted code and it seems we always have trouble with reimbursement.

A: As of the time this article was written, there are no new orthopedic codes slated for January 2022. That being said, there may be coding options available depending on the joint in the toe and the condition driving it. CPT 28285 — Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy) — isn’t only limited to a hammertoe diagnosis like ICD-10 code M20.41. It can also be used for claw toes and other deformities involving the phalangeal joints. The American Medical Association has quite a bit of guidance in this area, so be sure to check your CPT Assistant articles.

Bariatric EGDs for H. Pylori

Q: Do most insurances cover preoperative bariatric esophagogastroduodenoscopy (EGD) for Helicobacter pylori (H. Pylori)?

A: Preoperative EGDs are typically included in the global package for the bariatric procedure. In this scenario, it’s vital that the surgeon clearly documents the need for the EGD based on H. Pylori symptoms or prior testing and that it’s truly separate from a preoperative EGD for bariatric procedure.

Eustachian Balloon Dilations

Q: Can you provide us some information on eustachian balloon dilations and how to code them effectively?

A: Previously, coding for these procedures required the usage of the unlisted CPT 69799. In January 2021, two new codes were issued for these procedures:

• 69705 — Nasopharyngoscopy, surgical, with dilation of eustachian tube (ie, balloon dilation); unilateral
• 69706 — Nasopharyngoscopy, surgical, with dilation of eustachian tube (ie, balloon dilation); bilateral

As stated in the description, these dilations are performed via nasopharyngoscopy, unlike CPT 69420 and CPT 69421 that are performed via incision in the ear drum. Per the parenthetical note in the CPT manual, CPT 69706 and CPT 67905 should not be reported with CPT 31231 — Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure) — or CPT 92511 — Nasopharyngoscopy with endoscope (separate procedure).