Billing for an iatrogenic injury, my patient.

Question:

The surgeon reported an intestinal perforation caused by a trocar during a laparoscopic cholecystectomy due to extensive adhesions.  He completed the cholecystectomy and also did a suture repair of one perforation of the small intestine. How is this reported?

Answer:

Iatrogenic, intraoperative complications that are repaired at the same operative session are not separately reported. Since the small bowel perforation was an iatrogenic injury, inadvertently done by the surgeon during a surgery, it is not reported. Only the cholecystectomy should be reported.

*This response is based on the best information available as of 06/06/19.

30140 (Submucous Resection) vs 30130 (Excision)

Question:

My work RVUs are down this year.  I do a lot of inferior turbinate submucous resection surgery and I code 30140 (Submucous resection inferior turbinate, partial or complete, any method).  I noticed that the wRVUs for 30140 are now 3.00 and last year they were 3.57.  This is a big hit for me.  I want to use 30130 instead because it has higher wRVUs.  What do I need to document?

Answer:

If the procedure you perform is 30140 then that is the code you should use.  The code with higher RVUs that you want to bill, 30130, is not the same as a submucous resection.  It describes a through-and-through “excision” (first word of the code descriptor) of all or part of the turbinate.  Based on the information you’ve provided, it seems you are accurately coding the procedure.  The issue you’ve identified is that the RVUs for 30140 went down in 2018 to account for the fact that 30140 is now a 0-day global period procedure; it was a 90-day postoperative global period procedure prior to 2018 thus the higher wRVUs.

*This response is based on the best information available as of 5/23/19.

Ear Biopsy

Question:

What is the correct code for a tangential biopsy of the antihelical fold?  I was going to bill 11102, but I was told that there are different codes in other sections of CPT for some biopsies.

Answer:

The correct code would be 69100,Biopsy external ear.  As a bonus, this correct code would reimburse at a higher level than 11102.  According to the Medicare fee schedule, the national reimbursement rate for 11102 is $41.08 and for 69100 it is $50.45.

*This response is based on the best information available as of 5/23/19.

Endoscopic Cubital Tunnel Release

Question:

If a cubital tunnel release is performed by endoscopy how should it be reported? We report 64718 when it’s performed as an open procedure. Just not sure how to report it when it is done by endoscope.

Answer:

Thanks for your submission.  There is currently no Category I CPT code for endoscopic cubital tunnel release.  The March 2009 edition ofCPT Assistantadvised that it would be correct to report the procedure using code 29999 (Unlisted procedure, arthroscopy).

You could use the open procedure code for comparison, 64718 (Neuroplasty and or/transposition; ulnar nerve at elbow), or the endoscopic carpal tunnel release code 29848 (Endoscopy, wrist, surgical, with release of transverse carpal ligament).

*This response is based on the best information available as of 5/23/19.

Nerve Repair

Question:

I know that CPT code 64910 is the code I report for a nerve repair of the spine.  My question is when performing this procedure on three levels how to I report this.

Answer:

You would report CPT code 64910 for each level.  Since the second and third levels are bundled under NCCI you would append Modifier 59 to the second and third levels to indicate they are distinct and separate.  Also keep in mind the maximum number of levels you can bill on the same date of service for Medicare is 3.

*This response is based on the best information available as of 5/23/19.

Coding for Platelet-Rich Plasma Injections in the Spine

Question:

We are starting to do platelet-rich plasma injections in the spine.  Would we bill 64483?

Answer:

No because 64483 is specifically for an “anesthetic agent and/or steroid” injection.  The most accurate code is 0232T (Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed).  Be sure to obtain prior authorization as this service is oftentimes not covered.

*This response is based on the best information available as of 5/23/19.