Endoscopic Control of Epistaxis

Question:

We use coding software to help us with modifiers, procedure descriptions, RVUs etc. In the description for 31238 it mentions electrical cautery or laser but we use silver nitrate.  Is this code appropriate to use with use of silver nitrate only?

Answer:

The official AMA CPT instructions do not specify what tool or substance is used for control of epistaxis.  CPT 31238 merely states there is “control of nasal hemorrhage” endoscopically.  The most important aspect of this code is that the endoscope is held parallel to the instrument/tool/substance being used for epistaxis control.

*This response is based on the best information available as of 11/29/18.

Modifier 59 and 51. Do we need both?

Question:

Should we append both 59 and 51 when a code is bundled and is also a subsequent procedure?

Answer:

Modifier 59 is only used if two codes are bundled, specifically if there is a NCCI edits for the two codes. If there is no edit, a modifier 51 is used.  Over-use of modifier 59 is an audit target, so its use should be reserved for this scenario.

And when modifier 59 is used appropriately, a modifier 51 is redundant and unnecessary. Modifier 59 is always placed on a subsequent, lower valued code negating the need for modifier 51.

*This response is based on the best information available as of 11/01/18.

CPT Code 20610 or 20611?

Question:

Our physician performed a shoulder joint injection with ultrasound guidance.  The physician’s procedure note does not fully detail the ultrasound guidance, other than the ultrasound was used to do the injection. The physician does not document that images were saved (and we can’t find images).  The physician also does not have a separate report for the interpretation.  I am thinking we should report 20610 (large joint injection without ultrasound guidance) versus 20611 (large joint injection with ultrasound guidance).   Do you agree with my choice?

Answer:

Yes, the AMA published specific documentation requirements for the ultrasound-guided joint injections (20604, 20605 and 20611) when the codes were introduced in 2015.   In the absence of such documentation, the correct code is 20610.

CPT code 20611 requires the following:

• Documentation of a focused ultrasound evaluation.
• Obtain, label, and interpret images in multiple planes through the specific area of concern.
• Documentation of the normal anatomic structure and any pathologic findings.
• Documentation of separate stand-alone report for the patient’s chart (CPT code and radiology requirement).
• Documentation the procedure itself, including prep, intraservice work, and patient tolerance.
• Documentation of the specific medication and dosage if a therapeutic injection was performed.

*This response is based on the best information available as of 11/01/18.

Division and Inset of Flap

Question:

A patient presents for division and inset of a neck-to-ear pedicle flap.  Should we report 15620 or 15630?

Answer:

The CPT codes reported for the division and inset are chosen by the permanent inset site, not the donor site.  So in your case, CPT code 15630 (Delay of flap or sectioning of flap at eyelids, nose,ears, or lips) would be reported, not 15620 (Delay of flap or sectioning of flap at forehead, cheeks, chin,neck, axillae, genitalia, hands, or feet).

*This response is based on the best information available as of 11/01/18.

Trauma Laparotomy

Question:

Is there a specific CPT code for trauma laparotomy?

Answer:

No. if an exploratory laparotomy is performed and no injuries are detected and repaired,Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure)is coded. If the retroperitoneum is also explores code 49010Exploration, retroperitoneal area with or without biopsy(s) (separate procedure)instead of 49000. Both codes would never be reported together.

Note that each laparotomy code is designated as a separate procedure, meaning they are bundled if any more complex procedure is perfumed. So if the spleen is removed, the liver repaired, small bowel resections are performed, etc., only those definite procedures would be reported.

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

Coding Mesentery Repair

Question:

Documentation states that the mesentery was repaired as part of where the liver was packed. How is this reported?

Answer:

Code 44850,Suture of mesentery (separate procedure)is designated as a separate procedure and therefore is included in the more comprehensive procedure, the liver packing.  The separate procedure designation means that the procedure is usually a component of a more complex service and is not reported in addition to the more complex service in performed in the same anatomic area.

*This response is based on the best information available as of 10/04/18.