Using G0268 for Cerumen Removal

Question:

When would I ever use G0268 for cerumen removal vs 69210?

Answer:

G0268 is a HCPCS II code for “Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing” while CPT code 69210 says “Removal impacted cerumen requiring instrumentation, unilateral.”  Historically, G0268 was used for the otolaryngologist’s work to remove impacted cerumen on the same patient as the audiologist performed diagnostic testing on the same day and all services were billed by the physician.  Using G0268 allowed payment for the procedure performed by a different provider because cerumen removal by an audiologist would be included in the diagnostic testing service.

Since 2008 when Medicare required audiologists to bill for their services separate from the physician, we’ve not had to use G0268 as often.  Most payors will separately credential audiologists (which we recommend doing, by the way) so they can bill separate from the physician; again, decreasing the need to use G0268.

So when would you use G0268?  When you, the physician, are submitting a claim for removal of impacted cerumen as well as the diagnostic testing performed by your audiologist on the same dayandthat payor “bundles” 69210 with the diagnostic testing.  You’d use G0268, instead of 69210, to show a different provider performed the cerumen impaction removal.

*This response is based on the best information available as of 5/9/19.

Lumbar Sympathetic Plexus Block

Question:

I am new to pain management and am trying to find the correct CPT code for a lumbar sympathetic plexus block. Can you help?

Answer:

The correct CPT code is 64520 (Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic).

*This response is based on the best information available as of 5/9/19.

Laminoplasty

Question:

My surgeon did a C2-C7 laminoplasty and reconstructed with mini-plates. What code should I use?

Answer:

This procedure is reported using CPT 63051 (Laminoplasty, cervical, with decompression of the spinal cord, 2 or more vertebral segments; with reconstruction of the posterior bony elements (including the application of bridging bone graft and non-segmental fixation devices (e.g., wire, suture, mini-plates), when performed). CPT 63051 includes all levels of laminectomy required for the laminoplasty. It is not accurate to also bill a laminectomy code, such as 63001 or 63015, for procedures at the same level(s). CPT 63051 also includes placement of any instrumentation, such as the mini-plates, and fusion work performed at the same level, so do not also report an instrumentation code like 22842, or a fusion code such as 22600, 22614.

*This response is based on the best information available as of 4/25/19.

63042

Question:

When would I ever use 63042?  I am not sure I understand the meaning of this code.

Answer:

Good Question:!  CPT 63042 (Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar) is used when the diagnosis is recurrent herniated disc and a re-do discectomy is performed outside the post-operative global period of the initial discectomy.  It doesn’t matter if you did the original discectomy or another surgeon.  The point is that the patient has had a prior discectomy at that same spinal level more than 90 days (the post-operative global period of the lumbar discectomy code, 63030).  Be sure to document the fact that the patient had prior surgery, and when, at that specific level.

*This response is based on the best information available as of 4/25/19.

Call Coverage: Return to OR

Question:

I appreciate your patience in answering my Question:s.  I understand the E&M scenarios so let me throw in another type of call coverage relationship.  Recently, I returned a patient to the OR for the physician I was covering; the patient had dislocated their hip after a hip arthroplasty.  I reported CPT code 27266 without any modifiers; as I now understand the E&M rules I am wondering if I should have modified the code when I reported to the payor.

Answer:

Thanks for your comments and ensuring you are accurately reporting your call coverage scenarios.  CPT code 27266 is defined as “Closed treatment of post hip arthroplasty dislocation; requiring regional or general anesthesia “.   You are correct to present this scenario; the answer depends on whether or not the patient is in a global period.

If the patient is in the global period,you will append modifier 78, as the physician you are covering has to append this modifier.    Please note: if the patient had been in the global period and the hip dislocation was treated in the ER without anesthesia, the service would not be reportable according to Medicare rules.

If the patient is not in a global period, you may report CPT code 27266 without a global period modifier.

*This response is based on the best information available as of 4/11/19.

Sentinel Node Identification

Question:

We have a new plastic surgeon and he’s doing a procedure my other guys don’t perform.  The patient goes to radiology for injection of radioactive isotopes then to the operating room where my plastic surgeon excises the skin cancer and then injects blue dye and uses a gamma probe to identify a sentinel node.  Then he excises the sentinel node.  I’ve never coded lymph node procedures before – help!

Answer:

It’s always fun to learn something new, isn’t it!  For the lymph node removal procedure, look at codes 38500 – 38531 to see which code best matches the procedure he did.  Then you can also report +38900 (Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure)). CPT +38900 covers the intraoperative injection and use of the gamma probe to identify the sentinel lymph node.

*This response is based on the best information available as of 3/28/19.