Botox Injection in the Hand

Question:

I am trying to find a CPT code for a Botox injection in the right hand, and found CPT code 64653.  Is this the code I should report?

Answer:

There is not a specific CPT code for a Botox injection (chemodenervation) of the hands.  You should report the unlisted code CPT 64999 when performing the injection(s) on the hands and/or feet. Do forget to use a J code to report the Botox injected.

*This response is based on the best information available as of 3/14/19.

Global Period for Debridement

Question:

I thought the global period of debridement of muscle or bone was 10 days. Is that true?

Answer:

The debridement codes were revised in 2011 and the global period for all codes (11042-11047) was revised to 0 days.

*This response is based on the best information available as of 3/14/19.

Botox for Migraine Headaches

Question:

When you inject Botox for migraine headaches, can you bill the injection code more than one time? We normally go about this as a cosmetic procedure, but I just wanted to look into this to see if I could bill out CPT code 64615 for each muscle group that is injected?

Answer:

The CPT language is very clear that all four muscle groups, on both sides, must be injected for a total of 8 injections. CPT 64615 states Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine).  In your scenario, you will use 64615 and bill as 1 unit.

*This response is based on the best information available as of 3/14/19.

Bone Graft

Question:

My surgeon performed a repair of a nonunion with bone graft harvested via a separate incision.  The surgeon submitted CPT code 25431 alone.   I added CPT code 20902 after reviewing the operative note, because the surgeon obtained the bone graft from a distant site via a separate incision.   My surgeon disagrees with me and is firm that the harvest of the bone graft is not separately reportable.   Shouldn’t we be able to report the bone graft in addition to 25431 because of the separate incision?

Answer:

We appreciate your Question:! Although your physician did do the work of harvesting the bone graft from a separate incision, the rules associated with this code do not allow reporting 20902 (Bone graft, any donor area; major or large)

CPT code 25431 (Repair of nonunion of carpal bone (excluding carpal scaphoid (navicular)) (includes obtaining graft and necessary fixation), each bone) states in its definition the instructions “includes obtaining graft and necessary fixation).

You are correct that if a graft is obtained via a separate incision and is not inclusive to the code definition, or is not inclusive to a typical procedure, that the bone graft may be reportable in addition to the primary procedure.  For example, when a surgeon performs a subtalar arthrodesis defined by CPT code 28725 (Arthrodesis; subtalar) and harvests a bone graft from the proximal tibia, both 28725 and the bone graft (e.g.  20900 or 20902) may be reported.

*This response is based on the best information available as of 2/28/19.

Fascia Lata Graft Denials

Question:

We routinely bill 69631 (tympanoplasty) and 20922 (temporalis fascia graft).  We’ve been paid but now we’re being asked to give money back.  Can you help?

Answer:

A thigh fascia lata graft was not harvested to support 20922.  Rather, if a temporalis fascia graft is harvested through a separate skin incision then you may separately report 20926 (tissue graft).  However, if the tympanoplasty is performed via post-auricular incision then 20926 is not separately reported for the temporalis fascia graft since it is considered a “local” graft.

*This response is based on the best information available as of 2/14/19.

Peritoneal Catheter Placement

Question:

I placed the peritoneal catheter for a neurosurgeon placing a V-P shunt. Do I code 49419, insertion of peritoneal catheter?

Answer:

No, you are a co-surgeon with the neurosurgeon. Code 62223, creation of a ventriculo-peritoneal shunt, include both the neurosurgeon’s portion of placing the ventricular catheter and your portion of placing the peritoneal catheter. Both surgeon will report 62223-62.

*This response is based on the best information available as of 2/14/19.