Hip Injection

Question:

I did a left hip intraarticular steroid injection and used fluoroscopic guidance. Can I report the guidance in addition to the procedure?

Answer:

Yes, you would report CPT code 20610 for the hip injection and 77002-26 for the fluoroscopic guidance. Make certain you use Modifier 26 when performing procedure is a facility setting. Modifier 26 is used for the professional component. Do not report 27093 (Injection procedure for hip arthrography) when reporting CPT 20610.

Incident to Services

Question:

We just recently began hiring PAs to see patient to assist our pain physicians. Our pain doctors want the PAs to see new patients and bill under their NPI number. We see a large population of Medicare patients and I am worried this could get us into trouble.

Answer:

For Medicare patients if the PA sees a new patient the service must be reported under the PA’s NPI number. In order to bill under the physician’s NPI number the patient must be an established patient with an established plan of care. If the patient has a new problem or worsening problem either it must be billed under the PA’s NPI number, or the physician must see the patient on that date of service. If the criteria is met for incident to also keep in mind the physician must be in the office suite and immediately available but does not be in the room.

Question:We have a debate in or office. Our doctors always bill an E/M service with a procedure in the office. For example we had a patient the other day in which the reason for the visit was a trigger point injection. The physician submitted 99213-25 and 20552 for the trigger point. I am new to this specialty, but I was always instructed that if the reason for the visit is the injection, we can only bill the injection. Which is correct?

Answer:
When the reason for the visit is the injection and there is not a significant separately identifiable service then only the procedure is reported (20552) Keep in mind there is an inherent E/M service in every procedure. Any discussion or evaluation related to the injection before the procedure would be considered included in the trigger point preservice time of 11 minutes.

Remote Patient Monitoring

Question:

We are going to begin using remote therapeutic monitoring in our pain practice to monitor our patients pain functional status and compliance with exercise therapy. For the initial set up and education can our MA perform this service?

Answer:

Yes, the clinical staff may perform the initial set up, and education on setting up the device as long as a physician or other qualified healthcare professional prescribes it. Unlike remote physiologic monitoring, the remote therapeutic monitoring codes (RTM) must be provided under direct supervision which means the physician or other qualified QHP must be in the office suite. However until the year in which the public health emergency (PHE) ends audio visual communication is accepted as direct supervision. Once the PHE ends, this will no longer be the case. The correct CPT code to use for the initial setup and patient education is 98975.

ER Visit Coding

Question:

What code do use when our pain doctor sees a patient in the emergency department for a consultation at the request of the ED physician? Our pain doctor treated the patient and discharged the patient from the ED.

Answer:

Since the patient was not admitted your physician to the hospital you code it as an ED visit, 9928x, when the payor does not recognize the consultation (9924x) codes.

Billing for a Neurostimulator Implant

Question:

My physician billed implanted a neurostimulator into the sacral nerve for urinary incontinence. We billed CPT codes 64562 and 95972 for a Medicare patient. Medicare denied CPT 95972 for the analysis and programming. My physician says it should be paid and we should appeal. Can you provide advice?

Answer:

Based on CPT guidance (February CPT Assistant 2019; “When a neurostimulator or its components is implanted, electronic analysis is inherently included as part of the implantation procedure.” You cannot report the analysis and programming of a neurostimulator on the same date of service as it is included in the implantation of the device.

Acute versus Chronic Conditions for Office E/M Services

Question:

When determining if an illness is chronic versus acute is it based on how long the patient has had the condition or is it based on if the condition is considered a chronic or acute condition?

Answer:

The AMA defines chronic as: A problem with an expected duration of at least a year or until the death of the patient.

An Acute problem is “A recent or new short-term problem with low risk of morbidity for which treatment is considered. There is little to no risk of mortality with treatment, and full recovery without functional impairment is expected.” An acute problem can be uncomplicated, acute complicated or acute with systemic symptoms. Please reference thislinkfor the AMA definitions.

Keep in mind the practitioner should document the whether the condition is acute or chronic if the condition is stable or exacerbating.