Risk of Patient Management

Question:

I am a Pain Management Physician. I have a patient with lumbar spinal stenosis who has completed two months of physical therapy and 2 epidural steroid injections, but significant pain still persists. Since extensive conservative management has failed to provide adequate relief, I now recommend a surgical consultation with a spine physician. I document, “We discussed risks of surgery including bleeding, infection, nerve damage as well as patient-specific risks including hypertension. After discussing the risks and benefits of surgery, the patient elects to continue conservative management”. Does this count as a decision for surgery (moderate risk)? I am not clear on if I can make a “decision for surgery” as a non-surgical physician.

Answer:

Thank you for your inquiry. In answer to your question, no, this would not be a decision for surgery on the MDM table of risk. You are not the surgeon; you are considering a surgical consultation. The surgeon is the provider who makes the decision for surgery.

*This response is based on the best information available as of 10/17/24.

Sphenopalatine Ganglion Block with Medication Delivery

Question:

One of our physicians is 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 we report 64505 for this service?  If not, what is the best code to report?

Answer:

 There is no specific CPT code that accurately describes the service.  The code set includes CPT 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. 

Another variation on blocking the sphenopalatine ganglion is using a Q-tip to apply anesthetic topically through the nose. There is no specific CPT code for this procedure, which is best reported as part of the E/M service. 

*This response is based on the best information available as of 10/17/24.

Paraspinal Intramuscular Injections

Question:

The type of injections our physicians perform are best described as paraspinal intramuscular injections or paraspinal nerve blocks without radiographic guidance. We are unsure how to code this procedure. What is the best code to use?

Answer:

Any injection around the spine without imaging guidance is best described as a trigger point injection.  The number of muscles injected determines whether CPT code 20552 (1 or 2 muscles) or CPT code 20553 (3 or more muscles) is billed.  If one muscle is injected multiple times, it should be coded with the lower code 20552.

*This response is based on the best information available as of 9/16/24.

Fall Risk Prevention Program: Part 2

Question:

We read and received your recent Coding Coach on the Fall Risk Prevention Program and directive to report Category II CPT codes for this service. We have a follow-up question.  Why would we not be able to report CPT code 97750 for this service, and can this code be billed incident-to the physician if the MA performs the work?   

Answer:

Per CPT coding guidelines, many parameters are associated with reporting CPT code 97750. CPT code 97750 is not used for a MIPS tracking code. Reporting this code requires that the work be performed by an MD, DO, or PT. An MA may not perform the work associated with this code and bill incident - to, as an MA is not a Qualified Healthcare Professional (QHP). 

*This response is based on the best information available as of 9/16/24.

Splanchnic Nerve Injection

Question:

We are unsure what CPT code to use when our physician injects the splanchnic nerve with phenol. Is this an unlisted CPT code? 

Answer:

Since the splanchnic nerve is part of the celiac plexus, and phenol is a neurolytic agent, you should report CPT code 64680, Destruction by neurolytic agent, celiac plexus, with or without radiologic monitoring. (For an injection of other substances such as an anesthetic and/or steroid, not a neurolytic agent, use code 64530 Injection, celiac plexus).

*This response is based on the best information available as of 9/9/24.

Fall Risk Prevention Program: Part 1

Question:

We want to institute a Fall Risk Prevention Program in our practice to take advantage of CMS's Merit-based Incentive Payment System (MIPS). Based on CMS’s 2024 Quality Measures List, what codes should we report, and can our practice's medical assistant (MA) capture this work? 

Answer:

It is great that your practice will institute a Fall Risk Prevention Program to capture MIPS. According to CMS’s 2024 Quality Measures list, there are 2 measures reportable in this category. 

Quality measure number 155 - Falls: Plan of Care. This measure is designed to capture the percentage of patients aged 65 years and older with a history of falls who had a plan of care for falls documented within 12 months. 

Quality measure number 318 – Falls: Screening for Future Fall Risk. This measure is designed to capture the percentage of patients 65 years of age and older screened for future fall risk during the measurement period. 

Per CPT, these quality measures should be reported with Category II tracking codes, which are used for performance measurement. 

The applicable category II CPT codes for these MIPS measures are as follows: 

• 1100F: Patient screened for future fall risk; documentation of 2 or more falls in the past year or any fall with injury in the past year (GER). 

• 1101F: Patient screened for future fall risk; documentation of no falls in the past year or only 1 fall without injury in the past year (GER). 

An MA can capture the work to assist the clinician when reporting these Category II CPT codes. 

*This response is based on the best information available as of 9/5/24.