ICD-10-CM Code for DBS Battery/Generator Replacement

Question:

We are using the diagnosis code of T85.190 (Other mechanical complication of implanted electronic neurostimulator of brain electrode (lead), initial encounter) for the replacement of a deep brain stimulator generator (2 leads, 61886) because the battery died. This code requires a 7th digit and we are struggling with the difference between initial encounter (A) and subsequent encounter (D) for this case. It’s not an injury or fracture which makes it more difficult to decide. Can I get your expertise?

Answer:

A couple of Question:s/ comments about this:

1. Why are the leads being replaced? Are they dislodged or out of place? If so, then a T code is appropriate.
2. For routine battery replacements because the battery has reach its end of life (a normal occurrence – not a complication), we’d use the condition code such as Parkinson’s disease (G20) and not a T code.

If you’re using a T code then you have 3 choices for the 7th character: A for initial encounter, D for subsequent encounter, and S for sequela.  The service is not being performed for a sequela so you can eliminate the 7th character of S.  So now you’re between A and D.  Since the patient is receiving active treatment for the “other mechanical complication”, you’ll use the 7th character of A (T85.190A).

*This response is based on the best information available as of 05/31/18.

Confused about CPT Code 26600

Question:

I am confused on how to report the closed treatment of multiple metacarpal fractures (26600) that are not displaced and treated with the application of a fiberglass short arm cast.    We are receiving denials when reporting the code for each fracture.

Answer:

The official definition of CPT code 26600 (Closed treatment of metacarpal fracture, single; without manipulation, each bone) instructs the physician to report CPT code 26600 for each bone that is fracture and treated without manipulation.

Several years ago, CMS implemented NCCI guidelines instructing that non-manipulative fractures that are treated with a single form of stabilization (e.g. cast) may only be reported as a single fracture.  This NCCI guideline also applies to situations where a patient may have both a displaced and non-displaced fracture treated with the same cast or splint.

The denials are correct if the payor is Medicare based on NCCI edits.  If the denials are coming from private payors, review the contracts to determine if the claim processing rule is agreed to in the contracts.  Appeal all denials to private payors citing CPT rules and hopefully contract agreement language.

*This response is based on the best information available as of 05/31/18.

Steroid Injection

Question:

How do I code a left hip intraarticular steroid injection under fluoroscopic guidance?

Answer:

You would report CPT 20610 (Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa); without ultrasound guidance) for the injection and CPT 77002 for the fluoroscopic guidance which can be reported in addition to the injection.

*This response is based on the best information available as of 05/17/18.

Billing Vertebral Angiograms

Question:

Do I have to have the catheter is the vertebral artery to bill a vertebral angiogram?

Answer:

Not necessarily.  See the code descriptions below for vertebral imaging.  If the catheter is selectively placed in the subclavian or innominate artery and vertebral circulation is imaged and documented, code 36225 is reported. If the catheter is selectively placed in the vertebral artery and vertebral circulation is imaged and documented, code 36226 is reported.

CPT Code	Description	Vessels imaged
36225	Selective catheter placement, subclavian or innominate, unilateral	Ipsilateral vertebral circulation, including arch
36226	Selective catheter placement vertebral artery, unilateral	Ipsilateral vertebral circulation, including the arch

*This response is based on the best information available as of 05/17/18.

Coding 19120 vs 19301

Question:

What’s the difference between code 19120, breast mass excision and 19301, partial mastectomy/lumpectomy?

Answer:

Both codes describe the excision of a lesion in the breast.  Code 19120 is describes the excision or open removal of a cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion.

In contrast, code 19301 also describes removal of a lesion by performing a partial mastectomy, for example a lumpectomy, tylectomy, quadrantectomy, or segmentectomy.However, this code requires the necessity and documentation of attention to the removal of adequate surgical margins surrounding the breast mass or lesion.

*This response is based on the best information available as of 05/03/18.

ICD-10-CM Code for Spinal Stenosis

Question:

Should the code set M48.0- be used for both central canal stenosis and foraminal stenosis?

Answer:

There is no distinction made in ICD-10-CM for central canal stenosis vs foraminal stenosis. Therefore, the M48.0- code covers both/all types of spinal stenosis.

*This response is based on the best information available as of 05/03/18.