Repairs with Mohs Surgery

Question:

I know that simple repairs are included with lesion excisions, but what about Mohs surgery?

Answer:

Although simple repairs are included (bundled) into almost all integumentary codes, no repair is bundled into Mohs per the NCCI and CPT. The CPT guidelines for Mohs state that if a repair is performed, you can use separate repair, flap or graft codes to report. You can report simple repairs (12001-12018) along with Mohs codes (17311-17315).

*This response is based on the best information available as of 02/15/18.

Debridement of the External Auditory Canal

Question:

I can’t find a CPT code for debridement of the EAC such as for Swimmer’s ear. Help!

Answer:

Actually there isn’t one! Typically the debridement is performed with a microscope so you may report 92504 (binocular microscopy) with your E/M code assuming your documentation supports it. Do not use a code such as 11000 (Debridement of extensive eczematous or infected skin; up to 10% of body surface) as the intent of this code is not for use in the ear canal.

*This response is based on the best information available as of 02/15/18.

Breast Cyst Aspiration

Question:

The surgeon did a fine needle aspiration of two cysts in the same breast without any imaging. Is this billed once or twice?

Answer:

Fine needle aspiration of a breast cyst is reported per cyst. In this scenario, code 10021 with 2 units or 10021 and a second 10021 with a 59 or XS modifier as directed by your payor.

The fine needle aspiration codes are shown below.

Fine Needle Aspiration (FNA)

CPT Code	Description
10021	Fine needle aspiration; without imaging guidance
10022	with imaging guidance

Global Period for both codes – XXX*XXX means the concept of global period does not apply

*This response is based on the best information available as of 02/01/18.

Laparoscopic Pyloroplasty Coding

Question:

How is a laparoscopic pyloroplasty reported?

Answer:

There is no current CPT code laparoscopic pyloroplasty, only an open code. An open code may not be used if a procedure is done laparoscopically. An unlisted code must be used. In this case, use code 43659, unlisted laparoscopic procedure, stomach.

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

New Endoscopic Sinus Surgery Codes

Question:

I heard there are new endoscopic sinus surgery codes. What’s the scoop?

Answer:

Yes!  There are a couple new codes this year that bundle an endoscopic total ethmoidectomy with a:

• frontal sinusotomy – new code 31253
• sphenoidotomy without tissue removal – new code 31257
• sphenoidotomy with tissue removal – new code 31259.

Use one of the bundled codes first before using a code(s) for other sinuses addressed (maxillary, sphenoid, anterior ethmoidectomy).

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

Removal of Tissue Expander in the Office

Question:

I have a question on tissue expander coding. How would I code for an in office procedure on a tissue expander removal under local anesthesia? The patient had breast cancer and the mastectomy was performed at a different facility. The patient’s tissue expander became exposed so the expander was removed at my facility in the office. I was trying to find some coding guidelines on this scenario. Any help you can give me would be greatly appreciated!

Answer:

The CPT code for removing a tissue expander in the office is the same as it is if the TE was removed in the hospital – the physician reports 11971 (Removal of tissue expander(s) without insertion of prosthesis). Medicare’s payment for the physician in the office (place of service 11) is somewhat higher than the payment in the OR (place of service 24, 22, 21).

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