Inpatient E/M Coding

Question:

I did an inpatient consultation and coded 99253 (non-Medicare). I did not need to follow the patient, so I signed off. They asked me to re-consult a week later. What is the code for a re-consult?

Answer:

There are no specific E/M codes for an inpatient re-consultation. You will use the subsequent hospital care code, 9923x, since it is the same admission for the patient.

Question:Follow up question: the patient was discharged then admitted a month later and I was consulted again. Is this a subsequent hospital care code?

Answer:

No, since it is a new admission for the patient, you will use the consultation code again (9925x).

Question:Last question: when I see the patient in my office a month later, is it a new patient?

Answer:

No, it is an established patient (9921x) because you have had a face-to-face visit with the patient in the previous 3 years.

Waiving Medicare Cost-share for Telehealth Visits

Question:

I heard that Medicare patients don’t have to pay their deductible or coinsurance if they have a telemedicine visit. Is this true?

Answer:

Medicare is not waiving deductibles or co-insurance. However, they are allowing providers to do so at their discretion without penalty for telemedicine visits. This means the provider will only be reimbursed what Medicare pays, if the provider chooses to waive the patient portion of the visit. Many payors are waiving cost-sharing for telemedicine visits. See Payor Telehealth Policies for more information.

Steroid Injection

Question:

What CPT code would you use for “anesthetic and steroid injection of the left posterior superior iliac spine?

Answer:

You would report the injection with CPT code 20552.

*This response is based on the best information available as of 08/05/21.

Trigger Finger Injection

Question:

Which CPT code is used 20550 or 20551 for a trigger finger /A1 pulley injection?

Answer:

CPT code 20550 defines an injection to a single tendon sheath, or ligament, aponeurosis (eg, plantar “fascia”).CPT code 20551 defines an injection to single tendon at the origin/insertion site.Trigger finger injections are most commonly given to the flexor tendon, supporting CPT code 20550.

*This response is based on the best information available as of 06/10/21.

Can I Bill for Fluoroscopy?

Question:

I did a left intraarticular steroid injection in the ASC. I used fluoroscopic guidance. Can I report the Fluoro separately or is it included in the procedure code I used 20610?

Answer:

Yes, you can report fluoroscopic guidance with CPT code 20610. In the ASC make sure you report 77002-26. Modifier 26 is required when you perform guidance in the hospital or ASC when the equipment is owned by the facility.

*This response is based on the best information available as of 01/21/21.

Sphenopalatine Ganglion Block

Question:

I cannot find a CPT code to report using a device to deliver medication through the nose when a sphenopalatine ganglion block is performed under fluoroscopic guidance for patients with migraine headaches. Can you provide me with the correct CPT code?

Answer:

There is no specific CPT code that accurately describes this service. The code set includes code 64505, which describes the injection of the sphenopalatine ganglion. However, it is inappropriate to  report this code since an injection is not performed. Therefore, the unlisted code 64999, Unlisted procedure, nervous system, should be reported.

*This response is based on the best information available as of 08/06/20.