When is it OK to “Unbundle” 22845 from 22853?

Question:

When is it acceptable to use modifier 59 on 22845 to unbundle it from 22853?

Answer:

To “unbundle” +22845 from +22853 and have it separately paid, you will report +22845 with modifier 59.  This is appropriate if you use a completely separate plate that spans the interspace, it can provide independent stabilization, and is not considered integral to the intervertebral device (+22853).

*This response is based on the best information available as of 07/26/18.

Multiple Fasciotomies Same Hand for Dupuytren’s

Question:

Our hand surgeon, not infrequently, will perform multiple fasciotomies in the hand for the treatment of Dupuytren’s.  We are reporting CPT code 26045 for each fasciotomy but now we are Question:ing if this is correct or not.  Before we refund claims paid, will you tell us if this code is reportable multiple times in the same hand?

Answer:

CPT code 26045 (Fasciotomy, palmar (eg, Dupuytren’s contracture); open, partial) is reportable one time regardless of how many “fasciotomies” were performed.   The only time this code is reportable twice on the same day is if both hands were treated. The code is a “palmar” code, thus includes all work on the same palm.

*This response is based on the best information available as of 07/26/18.

Thrombolysis Through a Chest Tube

Question:

How is installation of tPA into a chest tube coded?

Answer:

Report this with the following codes:

CPT Code	Description
?32561	Instillation(s), via chest tube/catheter, agent for fibrinolysis (eg, fibrinolytic agent for break up of multiloculated effusion); initial day
?32562	subsequent day

Each of these codes is reported once per day only.

*This response is based on the best information available as of 10/30/18.

I&D of Abscess?

Question:

If one of our physicians uses a needle to puncture an abscess, but allows it to drain on its own and does not incise or aspirate anything into the syringe, can we bill 10060 for an incision and drainage of an abscess?  If not, could we use 10160 for puncture aspiration instead?

Answer:

No to both Question:s.  CPT code 10060 includes incision and drainage, and you stated no incision was made.  CPT code 10160 includes puncture and aspiration, and you stated no aspiration was made.  The puncture as indicated in your scenario above would be part of the E/M service performed for the patient at that encounter.

*This response is based on the best information available as of 07/26/18.

Bundling of +22845 with +22853

Question:

How do we avoid non-payment for 22845 with 22853?

Answer:

Good Question:! Medicare instituted a National Correct Coding Initiative (NCCI) edit between these two codes in April 2017.  This edit was established to make you really think and be sure about reporting both codes.  If indeed you are meeting the requirements of +22845 (completely separate plate that spans an interspace, plate is not integral to +22853), then you can report both codes.  You’ll need to append modifier 59 (distinct separate procedure) to +22845 to show the plate is completely separate from the intervertebral device (+22853).

*This response is based on the best information available as of 07/12/18.

Ligating a Vessel in a Trauma Patient

Question:

What codes are used for ligating a vessel due to a traumatic injury?

Answer:

See codes 37565-37618, below. Select a code based on the anatomic area of the vessel. For example, Ligation, major artery (eg, post-traumatic, rupture); neck for ligating the jugular vein.

CPT Code	Description
37565	Ligation, major artery (eg, post-traumatic, rupture); neck
37616	chest
37617	abdomen
37618	extremity

*This response is based on the best information available as of 07/18/18.