Carotid Endarterectomy Coding

Question:

Can carotid endarterectomy, 35301, be billed more than once if plaque is removed from common, internal and external carotid?

Answer:

Code 35301, thromboendarterectomy, including patch graft, if performed, carotid, vertebral, subclavian, by neck incision, includes removing plaque at the carotid bifurcation and includes all removal from the common, internal and external carotid arteries.

*This response is based on the best information available as of 09/20/18.

Coding a Colotomy

Question:

How is this scenario coded?  A segment of the colon is opened to remove a foreign body and then closed. No resection and no perforation.

Answer:

The scenario you describe is a colotomy; making an incision in the colon through which the colon is explored for biopsy or foreign body removal This is coded as 44025,Colotomy, for exploration, biopsy(s), or foreign body removal.

*This response is based on the best information available as of 09/06/18, 3:00 PM Central Time (CT).

Post-Tonsillectomy Bleed

Question:

I am being told that treating a post-tonsillectomy bleed in the ED with local anesthesia and silver nitrate will not be paid.  Is it true that the only code that would be reimbursed is bringing the patient back to the OR?

Answer:

Medicare says that the tonsillectomy’s 90-day postoperative period includes treatment of any complications (e.g., bleed) unless the patient is taken to the operating room.  So if this is a patient covered by Medicare, or Medicare payor, then the ED service would not be billed.  You’ll have to check your non-Medicare plans to determine their postoperative global period policy and whether services provided in the ED related to the surgical procedure are separately payable.

*This response is based on the best information available as of 09/06/18.

Coding Twist Drill Ventriculostomy with Craniotomy/Craniectomy

Question:

When is it ok to unbundle 61107 from the craniotomy/craniectomy code?

Answer:

It is acceptable to report both codes when the ventriculostomy placed via twist drill hole is performed through a completely separate approach/access point from the craniotomy/craniectomy.  For example, you’ve performed a right suboccipital craniectomy and place a left frontal twist drill hole for placement of a ventricular catheter.

*This response is based on the best information available as of 08/23/18.

Sebaceous Cyst Removal

Question:

We had a patient with a 3.5 cm sebaceous cyst removed from her abdomen.  The physician had to cut into the subcutaneous tissue to remove it.  Should we use a code from the Integumentary section or the Musculoskeletal section to report this removal?

Answer:

You would report the appropriate code from the benign lesion excision section (in your case, 11404) for the removal.  Sebaceous cysts are dermal in origin, even if they extend into the subcutaneous tissue, so they are not considered soft tissue tumors.

*This response is based on the best information available as of 08/23/18.

Bone Marrow Aspirate

Question:

Our surgeon aspirated bone marrow for a subtalar fusion. We are unsure how to report this. Are you able to help?

Answer:

Yes, with the guideline changes surrounding CPT code 38220 and the new code 20939, CPT instructs to report 20999 for bone marrow aspirate for other musculoskeletal fusions (non-spine).

(For aspiration of bone marrow for the purpose of bone grafting, other than spine surgery and other therapeutic musculoskeletal applications, use 20999)

*This response is based on the best information available as of 08/09/18.