Coding for Platelet-Rich Plasma Injections in the Spine

Question:

We are starting to do platelet-rich plasma injections in the spine.  Would we bill 64483?

Answer:

No because 64483 is specifically for an “anesthetic agent and/or steroid” injection.  The most accurate code is 0232T (Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed).  Be sure to obtain prior authorization as this service is oftentimes not covered.

*This response is based on the best information available as of 5/23/19.

63042

Question:

When would I ever use 63042?  I am not sure I understand the meaning of this code.

Answer:

Good Question:!  CPT 63042 (Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar) is used when the diagnosis is recurrent herniated disc and a re-do discectomy is performed outside the post-operative global period of the initial discectomy.  It doesn’t matter if you did the original discectomy or another surgeon.  The point is that the patient has had a prior discectomy at that same spinal level more than 90 days (the post-operative global period of the lumbar discectomy code, 63030).  Be sure to document the fact that the patient had prior surgery, and when, at that specific level.

*This response is based on the best information available as of 4/25/19.

Skull Base Surgery

Question:

My neurosurgeon did a craniotomy with removal of a frontotemporal meningioma with stereotactic navigation and the microscope.  I coded as 61512, 61781, and 69990-59. However, my doctor disagrees and wants to code as 61583, 61512-51.  What do you think?

Answer:

First, 61583 – a skull base surgery approach code that requires an osteotomy at the base of the anterior cranial fossa – cannot be reported with 61512 (craniotomy for supratentorial meningioma) because 61512 includes the approach.  Using both codes – 61583 and 1512 – is “double-dipping” on the approach.  We would need to see the operative note to recommend definitive CPT codes but it sounds, from your description, that 61512, 61781 and 69990-59 fit the procedure.

For more information on skull base surgery coding, please refer to Kim’s white paper, “Coding and Reimbursement for Endoscopic Endonasal Surgery of the Skull Base,” in the February 2019 issue of the Journal of Neurological Surgery. Here is the link:https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0039-1677682(member login required to read the full text).

*This response is based on the best information available as of 3/28/19.

Removal of Lumbar Drain

Question:

I received a call from one of our PAs regarding the removal of a lumbar drain (CPT 62272) originally placed for CSF drainage. Is the removal of a lumbar drain billable?

Answer:

The removal of a lumbar drain is not separately reported.

*This response is based on the best information available as of 12/13/18.

Coding Twist Drill Ventriculostomy with Craniotomy/Craniectomy

Question:

When is it ok to unbundle 61107 from the craniotomy/craniectomy code?

Answer:

It is acceptable to report both codes when the ventriculostomy placed via twist drill hole is performed through a completely separate approach/access point from the craniotomy/craniectomy.  For example, you’ve performed a right suboccipital craniectomy and place a left frontal twist drill hole for placement of a ventricular catheter.

*This response is based on the best information available as of 08/23/18.

When is it OK to “Unbundle” 22845 from 22853?

Question:

When is it acceptable to use modifier 59 on 22845 to unbundle it from 22853?

Answer:

To “unbundle” +22845 from +22853 and have it separately paid, you will report +22845 with modifier 59.  This is appropriate if you use a completely separate plate that spans the interspace, it can provide independent stabilization, and is not considered integral to the intervertebral device (+22853).

*This response is based on the best information available as of 07/26/18.