Coding a Colectomy with Diverting Ileostomy

Question:

How is a partial colectomy with diverting ileostomy coded? The partial colectomy codes say “with colostomy”.

Answer:

Thank you for asking. We have recently revised the recommendation for this procedure based on new information. It is appropriate to use codes that say “with colostomy” (for example, 44141, 44146, 44208) when a diverting ileostomy is performed instead of a colostomy. When these codes were originally valued the codes were valued foreither acolostomy or an ileostomy.

*This response is based on the best information available as of 01/19/17.

Excisional Biopsy

Question:

My doctor’s documentation for a biopsy indicates he performed an “excisional biopsy of the skin”. Is this correct?

Answer:

No, CPT does not have a code for excisional biopsy. It is either a biopsy (11100 or 11101) or a benign or malignant excision code. (114xx, 116xx). It is important to use the appropriate terminology in the documentation to make it clear what type of procedure is performed. It is important to remember that all excision codes include a biopsy.

*This response is based on the best information available as of 01/19/17.

New Spinal Cage Codes – 2017

Question:

I see that CPT code +22851, Application of intervertebral biomechanical device(s) to vertebral defect or interspace was deleted effective 1/1/17. What code do I now use?

Answer:

Three codes have been added to CPT 2017 to replace +22851:

• +22853 is used for a device, with fusion, with or without integrated anterior fixation
• +22854 is used for a device to fill a corpectomy defect, with fusion, with or without integrated anterior fixation
• +22859 is used for interbody device insertion without fusion

Note that +22853 and +22854 include the integral anterior instrumentation for device anchoring when that type of device is used. If you do not use integrated fixation, it is still the same codes, +22853 or +22854. If you use a separate plate, you may separately report a code such as +22845 when the plate meets the code criteria (e.g., the plate crosses the interspace, can provide independent stabilization, and can be used with any other type of interspace device).

*This response is based on the best information available as of 01/05/17.

Replacement Code for “Interbody Cage for Disc”

Question:

I see that CPT code 22851 – Application of intervertebral biomechanical device(s) to vertebral defect or interspace was deleted in 2017. What code do I use in 2017 for placement of an interbody cage for disc that does not have integral fixation and is being used for fusion? I see the new codes 22853 and 22854 both say with integral anterior instrumentation device for anchoring.

Answer:

Three codes have been added to CPT 2017:

• 22853 is used for interbody device insertion, with fusion, with or without integrated anterior fixation
• 22854 is used for interbody device insertion for corpectomy, with fusion, with or without integrated anterior fixation
• 22859 is used for interbody device insertion without fusion

Your options will be 22853 or 22854, depending on whether performing corpectomy. 22853 and 22854 both say “with integral anterior instrumentation for device anchoring when performed.”If you do not use integrated fixation, it is still the same codes. If you use a separate plate, that would be reportable when specific criteria are met (e.g. the plate crosses the interspace, can provide independent stabilization, and can be used with any other type of interspace device.)

*This response is based on the best information available as of 01/05/17.

Intralesional Injections

Question:

Can I Report CPT 11900 x 1 and 11901 for each additional injections for multiple nodular lesions?

Answer:

No. CPT 11900 and 11901 are used to report number of lesions, not number of injections. You would report 11900 for up to and including 7 lesions and 11901 if there are more than 7 lesions. Make sure you document the type of lesions injected (cystic, nodular, keloid, psoriasis, acne, etc.) and location of each individual lesion. You may also separately bill for the medication using an appropriate J code.

*This response is based on the best information available as of 01/05/17.

An Office Visit and an Injection. Can I Bill Both with a Modifier 25?

Question:

A colleague informed me that billing an office visit every time I give a patient an injection can lead to an audit. I also read a recent article where an orthopedic practice had to pay back millions of dollars partially for this reason. I typically bill an established patient visit with an injection, but I always add a 25 modifier on the visit. Does that mean I am safe from an audit?

Answer:

Unfortunately, no. It is true that an evaluation and management code, an E/M or office visit, can be reported with a minor procedure such as an injection, but only if the E/M is significant and separate and exceeds the “pre-service evaluation” that is inherent to the injection. Every minor procedure has time for pre-service evaluation included in the value of the procedure code. Medicare and other payors have become concerned that E/M’s are being routinely reported with minor procedures without considering if the extent of the visit was truly more than the pre-service evaluation already included in the procedure.

*This response is based on the best information available as of 12/15/16.