Cranial Tongs with ACDF

Question:

Are we able to report CPT code 20660 for the application of cranial tongs during an anterior cervical discectomy and fusion procedure? The surgeon documented the tongs were applied and removed during the operative case.

Answer:

Thank you for your inquiry. CPT code 20660 is the correct code for the application of cranial tongs. The full definition is “Application of cranial tongs, caliper, or stereotactic frame, including removal (separate procedure)”. First, in reviewing the code, please note that the code has a ‘separate procedure’ designation. This means that the work associated with this CPT code is an integral part of a more extensive procedure. This means that CPT code 20660 is not reportable with CPT code 22551 “Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2” (aka ACDF) which is reported for the anterior cervical discectomy and fusion code. The use of a tongs or head holders, etc. for intra-operative positioning of the head is inclusive to any spinal procedure.

Additionally, the lay description published in Encoder Pro includes the work of applying skull traction tongs; this inclusion in the description of the procedure and the separate procedure designation preclude the surgeon from reporting CPT code 20660 in addition to the ACDF procedure code.

Typically the codes associated with halo application are reportable when the halo is applied as a stand-alone procedure or the halo is applied for longer term stabilization meaning the patient leaves the operative suite with the halo applied.

*This response is based on the best information available as of 03/02/17.

Coding With 27193

Question:

My coder just said they deleted 27193 and replaced with 2 small no global period codes? Is that correct?

Answer:

They didn’t really replace it with 2 codes, they replaced 27193 with 27197…both codeswithoutmanipulation. They replaced 27194 with 27198, both codeswithmanipulation.

Notice the difference in the language for the non-manipulative treatment:

DELETED: 27193 Closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation without manipulation was replaced with

NEW: 27197 Closed treatment ofposteriorpelvic ring fracture(S), dislocation(S), and diastasis or subluxationof the ilium, sacroiliac joint, and /or dislocation(S) of the pubic symphysis and/or superior/inferior rami, unilateral or bilateral; without manipulation.

Note that both new codes have 0 global days, a big change for the 90 day global period of the deleted codes. There is also a notation thatevaluation and managementcodes should be used in place of the global code to report the closed treatment of ONLY anterior pelvic ring fracture(s) and or dislocation(s) pubic symphysis and/or superior/inferior rami, unilateral or bilateral; without manipulation.

*This response is based on the best information available as of 02/16/17.

Trigger Point Bundling

Question:

A trigger point injection and a joint injection are bundled by Medicare. Does that mean I can’t bill both if I do both at the same encounter?

Answer:

You are correct, trigger point injection (20552 or 20553) and a joint injection, for example, a shoulder joint injection, (20610) are bundled by Medicare. You will note, however, that a modifier is allowed to override this edit. Overriding the edit is appropriate if you are doing the procedures in different anatomic locations. Therefore, doing a trigger point injection in the shoulder along with a shoulder joint injection should not be billed together. A trigger point injection in a different anatomic location, for example the back, would be separately reportable with the appropriate modifier (59 or XS).

*This response is based on the best information available as of 02/16/17.

Coding Laparoscopic Resection

Question:

My doctor performed a laparoscopic resection of a pancreatic lesion. Can this be coded with the open code, since there is no laparoscopic code?

Answer:

CPT says that if there is not a code that describes specifically what was performed, you must use an unlisted code.

Since there are no laparoscopic codes for resection of a lesion of the pancreas, you would report 48999, unlisted code, pancreas. For setting a fee, you can compare the work to the most similar open code, 48120-48160. And remember, if a code does not specifically say “laparoscopic” in its description, it is intended as an open code only.

.*This response is based on the best information available as of 02/02/17.

Irrigation and Drainage

Question:

There is some confusion in my office as what is the difference between a simple and complication irrigation and drainage (I&D) of an abscess. Can you help?

Answer:

A simple I&D includes drainage of the pus or purulence from the cyst or abscess and is reported with CPT 10060. The physician leaves the incision open to drain on its own, allowing for healing with normal wound care. A complex I&D includes placement of a drainage tube to allow for continuous drainage or packing to facilitate healing and reported with CPT 10061. In certain cases, tissue excision, primary closure, and/or Z-plasty may be required. Incision and drainage of a blister requires of a “super infection” with pus and abscess formation. CPT 10061 often involves larger abscesses requiring probing to break up loculations and packing to promote ongoing drainage. A loculate region in an organ or tissue, or a loculate structure formed between surfaces of organs or mucous or serous membranes.

*This response is based on the best information available as of 02/02/17.

Septal Cartilage Graft and Septoplasty

Question:

My doctor did a septoplasty, CPT 30520, removed cartilage and fashioned it for a graft that he used in the surgical repair of vestibular stenosis, CPT 30465. Can we also code 20912 for the fashioning of the graft or just 30520 and 30465? I couldn’t find any CCI edits preventing this.

Answer:

Only one code, 30520 or 20912, may be reported as these procedures were performed through the same incision. What was the reason for the incision – to straighten the septum (30520) or to obtain the graft (20912)? Use whichever code is supported by the documentation but do not use both codes. .

*This response is based on the best information available as of 02/02/17.