On-Q Pain Pump Coding

Question:

My doctor repaired an inguinal hernia and also placed On-Q pain pumps. Can these be billed with an unlisted code?

Answer:

Good Question:! Any pain management provided by the operating surgeon, including placing On-Q pain pump, is part of the global package and not separately reported.

*This response is based on the best information available as of 03/03/16.

How to Use CPT Codes 64461, 64462 and 64463

Question:

There are three new CPT codes our physicians want to use: 64461, 64462 and 64463.  What are these codes used for and what are the rules for reporting them?

Answer:

CPT codes 64461-64462 are new codes in 2016 to report a paravertebral (PVB) block and are used to treat chronic pain such as thoracic pain.  The procedure involves the physician injecting analgesia in the paravertebral space and includes ultrasound and fluoroscopic guidance.  Report CPT 64461 for the first injection and add-on code 64462 for each additional injection.  CPT 64463 is only used when continuous infusion is performed via a catheter.

*This response is based on the best information available as of 02/18/16.

ICD 10: Aftercare Z Codes or 7th Character Code?

UPDATED

Question:

Patient has been seen in office during the global period after a rotator cuff repair for a sprain. No X-rays were taken. Internally we will record 99024. Would we assign Z47.89 or the sprain code to 99024?

Answer:

Thanks for your inquiry as your question gives us an opportunity to address documentation requirements and how sprains and strains are delineated in ICD-10-CM.

First, under ICD-10-CM descriptions, an acute injury to the rotator cuff muscle or tendon is described as a “strain”, under the subcategory S46,01- , not as a “sprain.”  Although there is also an ICD code for sprain of the rotator cuff capsule, S43.42-, that is not the structure that typically injured.

If you’ve determined that the problem is an injury, you will look to the S codes; if it is a chronic or recurrent problem, you will look to the M codes.

The ICD-10-CM options for a rotator cuff strain are:S46.011- Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulderS46.012- Strain of muscle(s) and tendon(s) of the rotator cuff of left shoulderS46.019- Strain of muscle(s) and tendon(s) of the rotator cuff of unspecified shoulder

Ideally the physician will document whether the strain affects the right or left shoulder; use of the unspecified code is reserved for cases when the laterality is not described.

If the patient is seen in the global period for the injury, then the 7th character D is applied to indicate routine healing following active treatment of an injury.

If the surgery was done to treat a chronic or degenerative condition coded from the M chapter, you will report Z47.89, Encounter for other orthopedic aftercare, provided the follow-up is uncomplicated.

*This response is based on the best information available as of 02/4/16.

Lysis of Adhesions In the Shoulder

Question:

We are having a debate in our office we hope you can help unravel. We want to report CPT code 29827 and 29825 together but our Coding Companion states that they are inclusive to each other and are bundled. Our surgeon is Question:ing the accuracy of this information.

Answer:

Your surgeon is correct to question this information. CPT code 29825 describes arthroscopic lysis of adhesions; CPT code 29827 describes an arthroscopic rotator cuff repair. According to the AAOS Global Service Data Guide, these two procedures are exclusive to each other. Each procedure is supported by the medical necessity of two separate conditions and have separately identifiable diagnosis codes. If your Coding Companion is based on Medicare payment rules, you will see the two services as bundled together. This is where it is important to understand the differences between CPT coding rules and Medicare payment rules.

For Medicare Part B carriers, you would not report the two codes together as there is an NCCI edit in place; CMS considers shoulders procedures on the ipsilateral procedure inclusive to each other when an edit exists thus, a modifier may not be applied (e.g. 59, XU) to the code combination. In your scenario, only the rotator cuff repair is reportable to Medicare Part B (remember, NCCI edits are for Medicare Part B and may apply to Medicaid also).

For private payors who follow CPT rules, the code combination is reportable together and represents correct coding.

*This response is based on the best information available as of 01/14/16.

Repair of Nasal Vestibular Stenosis

Question:

I am trying to come up with the right CPT codes for a repair of nasal vestibular stenosis so we can get it pre-certified. Can you help?

Answer:

Yes, you are wise to determine the correct codes for pre-certification, otherwise the surgery might not be paid if you billed different codes.  Look at 30465 – Repair of nasal vestibular stenosis (e.g., spreader grafting, lateral nasal wall reconstruction).  You may also report a separate code if you harvest graft material through a separate incision.  For example, you may report 20912 (Cartilage graft; nasal septum) if you harvest septal cartilage graft when you have not performed a septoplasty at the same operative session.  If you did a septoplasty (30520) and repair of nasal vestibular stenosis (30465) then you may not report 20912 for the septal cartilage graft harvested/obtained from the septoplasty.

*This response is based on the best information available as of 01/14/16.

Are Cast Re-Applications Included in the Global Period?

Question:

We are hospital employed and are being told that we cannot bill for cast re-applications in the global period. An article posted in the AAOS coding column tells us that cast re-applications are separately reportable and to append a modifier 58. We also understand that modifier 58 restarts the global period. In my old job, I was told by a billing company that post-op casting was included in the global period and was not payable unless there was a complication with the cast. Is a cast re-application billable in the global period when medically necessary and will the global period re-start?

Answer:

Thanks for your inquiry. For some readers this will be a very mundane Question:, but we are hearing this question more and more frequently so this is a good time to re-address how to report the services and why the services are reportable.

Let’s answer the first question first. Are cast re-applications billing during the global period? Yes! The first cast is inclusive to the global surgical CPT code, but re-applications are billable, assuming of course, that medical necessity is present. The following is the CPT citation: The very first sentence in the Application of Casts and Strapping section of CPT states, “The listed procedures apply when thecast application or strapping is a replacement procedure used during or after the period of follow-up care, or when the cast application or strapping is an initial service performed without a restorative treatment or procedure(s) to stabilize or protect a fracture, injury, or dislocation and/or to afford comfort to a patient.”

The answer to the second question is no, the global period will not re-start because splints and cast CPT codes have zero global days; as such, the global days cannot be reset or re-started.

*This response is based on the best information available as of 12/17/15.