Bone Marrow Aspirate Harvesting for Platelet Rich Plasma

Question:

Our physicians are asking us to report 38220 and 0232T when they harvest bone marrow aspirate from the iliac crest for platelet rich plasma and inject it during another procedure.  Is this correct?  If not, can we report 0232T?  What if the only service performed is a PRP injection using bone marrow aspirate?

Answer:

You’ve asked two Question:s, so we’ve provided two parts to our answer:

CPT Category III code 0232T was introduced in 2010 for reporting injection of platelet rich plasma to a targeted site; the code definition includes all harvesting, preparation, and image guidance for the service.  In August 2010 the AAOS published guidance inAAOSNowwhich explained “The new code is to be used only when PRP is performed in a complete separate patient encounter from a surgical procedure.”

Based on this direction, when PRP is injected during another procedure, whether using drawn blood or bone marrow aspirate, it is not separately reportable with the primary surgical service.

If PRP injection is the only service performed, then 0232T is the correct code.  In recent years some physicians have begun using bone marrow aspirate harvested from the iliac crest instead of drawn blood for PRP preparation, and reporting the harvesting using CPT code 38220.  The May 2012 edition ofCPTAssistantclarified that 0232T is the only code reportable for PRP injection, whether performed using drawn blood or harvested bone marrow aspirate.  In 2018 the definition of 38220 was changed to reflect that it should be used only for diagnostic bone marrow aspiration.  New code 20939 should be used when bone marrow aspiration is performed for bone grafting, for spine surgery only, via a separate incision.

*This response is based on the best information available as of 01/04/18.

Epistaxis Control

Question:

Can you explain when to use 30901 and 31231 rather than 31238? I’m confused.

Answer:

Sure! We discuss these codes in our national ENT coding workshop series (click here for future course dates/locations).  CPT 30901/30903 are used when you control epistaxis via means such as cautery but an endoscope is not used.  CPT 31238 is reported when the epistaxis is treated while you’re using an endoscope (ie, the scope and instrument to control epistaxis are parallel to each other in the nose).  CPT 31231 is a diagnostic code and may not be separately reported with either 30901/30903 or 31238 for services rendered at the same session due to the codes’ “separate procedure” designation by CPT.

*This response is based on the best information available as of 12/14/17.

Billing an Appendectomy with Another Surgery

Question:

Is an appendectomy separately reported when done with another abdominal procedure?

Answer:

If the appendectomy is performed for a medically indicated purpose, for example the appendix was involved in the disease process, it can be reported with an add-on code, +44955. See the description of this code below. No modifier would be appended to this code and you should expect 100% reimbursement since add-on codes are valued lower since they are always reported with another procedure.

44955: Appendectomy; when done for indicated purpose at time of other major procedure (not as separate procedure) (List separately in addition to code for primary procedure

*This response is based on the best information available as of 01/04/18.

92504 Binocular Microscopy

Question:

I used the microscope to examine both ears during an office visit because the middle ear Otoscopic exam was abnormal.  Can I report 92504 with modifier 50 (bilateral procedures)?

Answer:

No.  CPT 92504 describes using a microscope for an examination – it represents payment for using a separate piece of equipment for your exam.  The code is not reported twice, nor is modifier 50 appended, when both ears are examined.

*This response is based on the best information available as of 12/14/17.

Coding Carotid Angiography

Question:

I performed a right common carotid artery catheterization with extracranial common carotid and intracranial imaging and left internal carotid catheterization with carotid circulation imaging. Can I report this as bilateral, 36224 and 36223-50?

Answer:

The bilateral modifier is only used for the exact same procedure/code performed bilaterally.

In your scenario the codes will be:

36224	for the left internal carotid catheterization with intracranial imaging, and
36223-59	for the right common carotid artery catheterization with extracranial and intracranial imaging

*This response is based on the best information available as of 12/14/17.

Coding Transforaminal Injections

Question:

How would you report a left lumbar transforaminal epidural injection (Left L5-S1 and left S1) with fluoroscopic guidance?

Answer:

This is reported as 64483 for the first lumbar level (L5-S1) and + 64484 for the additional level (S1). The fluoroscopy is included.

*This response is based on the best information available as of 11/30/17.