Microscope with 63030 Issues

Question:

Why do some insurance companies pay for the microscope (+69990) when we bill it for a lumbar discectomy (63030) and some don’t? I don’t get it. What recourse do we have if it isn’t paid?

Answer:

First, CPT guidelines do not list 63030 as inclusive of the microscope so reporting 63030 and +69990 together is accurate per the AMA’s CPTcodingrules.  That said, Medicare has a National Correct Coding Initiative (NCCI) edit preventing payment for +69990 when billed with 63030 (and many other laminectomy codes).  This is Medicare’spaymentrule. Some non-Medicare payors follow this NCCI bundling edit and also will not pay.  On the other hand, some non-Medicare payors don’t follow this edit and do reimburse +69990 when reported with 63030.  If you are contracted with the payor who does not reimburse +69990, with 63030, then you likely don’t have much recourse because you are contractually obligated to follow their payment rules.

*This response is based on the best information available as of 06/28/18.

Thoracic Nerve Blocks

Question:

If I perform three separate injections at three intercostal levels can I report 64420 and 64421 x 2?

Answer:

No you should report 64421 (Injection, anesthetic agent; intercostal nerves, multiple, regional blocks). CPT code 64420 is used for a single injection and CPT 64421 is reported for multiple intercostal nerve blocks even when the injections are at three levels.

*This response is based on the best information available as of 06/28/18.

Piriformis Syndrome

Question:

What code do I use when my physician injects the piriformis muscle for piriformis syndrome under ultrasound guidance in the office? Do I report 64445 for the nerve injection?

Answer:

CPT code 20552 and 76942 for the ultrasound guidance. Per CPT Assistant April 2012; there is a significant difference in the work and procedure, as well as intent, between an injection of the piriformis muscle and the perineural injection of the sciatic nerve. The sciatic nerve injection code (64445) should not be used to report a piriformis injection. Piriformis muscle injection(s) should be reported using CPT code 20552, Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s).

*This response is based on the best information available as of 06/14/18.

Reporting Bowel Left in Discontinuity

Question:

What codes are reported if the bowel is left in discontinuity as part of damage control surgery?

Answer:

Since the bowel is resected but an anastomosis is not performed, report the appropriate bowel resection code with a 52 modifier for reduced services.

*This response is based on the best information available as of 06/14/18.

Total Hip Arthroplasty Question

Question:

We have a patient who underwent an open fixation of a femoral neck fracture five years ago and now presents for a total hip arthroplasty.   Someone mentioned that we should report a conversion to hip arthroplasty but we are not sure if this is a revision of one component plus a hemiarthroplasty?

Answer:

The advice you received related to reporting this as a conversion to total hip arthroplasty is correct.  The patient is not in a global period, so you will report 27132 (Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft).  The concept of reporting the conversion code versus a primary hip arthroplasty is that the patient has had prior open hip surgery, and the value of the conversion code reflects that the procedure is typically more difficult than a primary arthroplasty procedure.

Do not unbundle and report the removal of one component and a hemi-arthroplasty or other revision codes for the described circumstance.

*This response is based on the best information available as of 06/14/18.

Coding a Composite Graft with Harvested Cartilage

Question:

I performed a composite graft (CPT 15760), and harvested cartilage from the ear.  Can I report for the harvesting?  If yes, what code do I use?

Answer:

You can report both 15760 (Graft; composite (eg, full thickness of external ear or nasal ala), including primary closure, donor area) and CPT 15040 (Harvest of skin for tissue cultured skin autograft, 100 sq cm or less) for harvesting the graft.  These two codes are not bundled under the National Correct Coding Initiative and can be reported together.

*This response is based on the best information available as of 06/14/18.