E/M Coding Based on Time

Question:

Our physicians’ defaults to time for almost every office encounter. We are working with them on documentation and what work contributes to total time and what does not. They perform their own independent interpretation of X-Rays (we bill globally) and performs procedures such as for example a shoulder injection or a genicular nerve injection in the office. They are counting the total time spent with the patient, including these activities and we do not believe that is correct. Can you help?

Answer:

Thank you for your inquiry. We will not address the default to time for almost every encounter other than to say medical necessity must be present for time spent. With that said, the activities you identify, because they are billable services represented by other CPT codes (aka are separately reported), do not contribute to the total time spent; this time must be deducted from the total time, assuming the E/M service is reportable.

Modifier Order on CMS Claim Form

Question:

We are submitting a hospital claim form with the modifier 25 and FS modifier. We are unsure which modifier to list first. What is your recommendation?

Answer:

Thanks for contacting KZA and remembering to use the FS modifier for shared services provided in the hospital. KZA recommends placing modifier 25 first, as this is considered a reimbursement modifier followed by the FS modifier, which is an informational modifier.

Chemodenervation with Needle Electromyography

Question:

My doctor performed chemodenervation on all four extremities using needle electromyography. We use CPT code 95874 for the electromyography. My question is do I only report CPT 95874 once for all 4 extremities or can I report 95874 it for each extremity. Do I need to add Modifier 59?

Answer:

Yes, you can report needle electromyography with chemodenervation for each extremity. However, report only one guidance code per chemodenervation code.

Somatic Nerve Injections

Question:

When reporting an injection of a steroid of the brachial plexus can I report imaging such as ultrasound guidance?

Answer:

CPT code 64415 is reported for a injection of an anesthetic agent and/or steroid of the brachial plexus. Per CPT imaging guidance is included in the code and cannot be reported with CPT codes 76942, 77002 or 77003.

Coding for Trigeminal Neuralgia

Question:

How is RFA rhizotomy of the trigeminal nerve at the second and third division branches of the foramen ovale? The diagnosis was Trigeminal Neuralgia

Answer:

This procedure is coded as 64605,Destruction by neurolytic agent, trigeminal nerve second and third division branches at foramen ovale.Code +77002 may also be reported if fluoroscopy is used, documented, and a permanent image is retained.

SI Joint Injection

Question:

What CPT code do we use when our physician performs an SI joint injection using ultrasound guidance? CPT code 27096 states with fluoroscopy or CT guidance.

Answer:

CPT instructs to report CPT code 20552 for unilateral or bilateral SI joint injections if CT or Fluoroscopic imaging is not used. CPT code 76942, for the ultrasound guidance, may be reported if the documentation requirements are met.