63005 vs. 63047

Question:

Help me understand the difference between 63005 and 63047 – I don’t get it! The codes look the same to me.

Answer:

Yes, it can be confusing because the code descriptions are very similar. However, look very carefully and you’ll see the differences. Here are the code descriptions and I’ve bolded some key differences:

CPT Code	Description
63005	Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy, (e.g., spinal stenosis), one or two vertebral segments; lumbar, except for spondylolisthesis
63047	Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (e.g., spinal or lateral recess stenosis)), single vertebral segment; lumbar

CPT 63005 is generally used for removal of the lamina to provide central decompression of the spinal cord. CPT 63047 involves not only removal of lamina for central decompression but also lateral recess decompression in the form of a facetectomy (e.g., medial, partial) and/or foraminotomy for nerve root decompression.

*This response is based on the best information available as of 08/27/15.

Different Specialties, Same Tax ID

Question:

Can you help clarify the new patient rules related to multiple specialties in the same group practice? If we have different specialties (e.g., Pain Management, Podiatry, Rheumatology, Orthopaedics) can we charge a New Visit code when the patient is seen for the first time by a physician in a different specialty in the practice?

Answer:

Yes, the CPT rules and Medicare rules both allow the new patient visit rules in your scenario, which is very common in large multi-specialty groups or academic centers where all specialties bill under the same tax ID. The following is a direct citation from the 2015 AMA CPT Manual: “Solely for the purposes of distinguishing between new and established patients, professional services are those face-to-face services rendered by physicians and other qualified health care professionals who may report evaluation and management services reported by a specific CPT code(s). A new patient is one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.”

Thanks for reaching out to KZA for your coding needs!

*This response is based on the best information available as of 08/13/15.

Lipoma Removal

Question:

I removed a huge lipoma from a patient and it seems like the benign skin lesion removal codes just don’t describe what I’m doing. Is there another code I can use?

Answer:

Yes! The “soft tissue tumor” codes were introduced into CPT in 2010 and better describe the procedure you are performing. These codes are located in the Musculoskeletal System section of CPT (e.g., 21555, 21556) rather than in the Integumentary System section of CPT (114xx for excision of benign skin lesions, 116xx for excision of malignant skin lesions).

*This response is based on the best information available as of 07/30/15.

CPT or HCPCS Tool?

Question:

We have recruited a new hand surgeon and she frequently applies aluminum finger splints which are molded by the surgeon or her medical assistant. Can we report CPT code 29130 for the application and molding of this splint?

Answer:

Thanks for this great Question:! The application of the splint code 29130 is not reportable for an off the shelf product such as the aluminum splint. Report the appropriate HCPCS code for the supply only.

*This response is based on the best information available as of 07/02/15.

Paramedian Forehead Flap After Mohs Surgery

Question:

I did a paramedian forehead flap after the Mohs surgeon removed the cancerous lesion from the nose. What is the CPT code for this procedure and do I need a modifier because I’m in the Mohs surgeon’s global period?

Answer:

The code is 15731 (Forehead flap with preservation of vascular pedicle (e.g., axial pattern flap, paramedian forehead flap)). You should not need a modifier because you are a different specialty (Otolaryngology) from the Mohs surgeon (Dermatology) and payers should not consider you to be in the Mohs surgeon’s global period.

*This response is based on the best information available as of 05/21/15.

ICD-10: Procedural Coding System vs. CPT Codes

Question:

Now that ICD-10 is going to happen I’m starting to look into it a bit more. I see there is a procedural coding system component. Are we going to have to use that instead of, or in addition to, CPT?

Answer:

Good Question:. The ICD-10 procedural coding system (ICD-10-PCS) is used by facilities (e.g., hospital) to code procedures. CPT codes are, and will continue to be, used by physicians (and other providers) to report professional services. The two systems are unique and very different. You will not be using ICD-10-PCS to report professional services; rather, you will continue to use CPT codes. You will, however, be changing from ICD-9-CM (ICD-9 Clinical Modification) diagnosis codes to ICD-10-CM diagnosis codes on October 1, 2015 for claims submitted to HIPAA-covered entities. So the good news is that the CPT coding system is not changing for physicians – only the diagnosis coding system will be different.

*This response is based on the best information available as of 04/23/15.