Reporting a Cholecystectomy and an Umbilical Hernia at the Same Operative Session

Question:

If a patient undergoes an open cholecystectomy and has a reducible umbilical hernia repaired during the same operative session, through separate incisions, can both be reported?

Answer:

Yes, if both procedures were performed through separate incisions both may be reported. Conversely, if both were repaired through the same incision, only the cholecystectomy would be reported.

*This response is based on the best information available as of 08/08/19.

Lesion Excision and Repair

Question:

I saw a patient for an excision of a squamous cell carcinoma on his chest. The size is 4.2 cm diameter. I know I report 11606 for the lesion excision but I also did an intermediate repair with a layered closure and the side is 6.5cm. Can I bill for the repair or is it included? My coder says it is billable with Modifier 59. Can you provide some guidance?

Answer:

You are correct that you report CPT code 11606 (Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter over 4.0 cm) for the excision. Yes you can report the repair based on CM size which would be coded with CPT code 12032 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm). You would not append Modifier 59 since it is not a bundled service. The correct modifier to use is 51 and append it to the lesser RVU procedure which is the repair.

*This response is based on the best information available as of 07/25/19.

DBS Battery Replacement

Question:

When our doctors replace a DBS generator because the battery is depleted and they reprogram at the same time, we can bill for the programming, correct?

Answer:

Yes, you can code for the generator replacement using 61885 (or 61886 if the two leads – right and left – are connected to one battery).  You can also code 95983 if the reprogramming is truly performed by the surgeon (and not a company rep) and the parameters programmed to are documented (e.g., amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation).  The surgeon must do the programming him/herself – not the vendor rep – and document the actual parameters in order for the neurosurgeon to bill for the programming.

Note that the DBS programming codes changed in 2019.  The old codes, 95978 and +95979, were deleted. The new codes are:

95983

Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain neurostimulator pulse generator/transmitter programming, first 15 minutes face-to-face time with physician or other qualified health care professional

+95984

with brain neurostimulator pulse generator/transmitter programming, each additional 15 minutes face-to-face time with physician or other qualified health care professional (List separately in addition to code for primary procedure)

The old codes were for a time frame of an hour whereas the new codes are now in 15 minute increments.

*This response is based on the best information available as of 07/25/19.

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 07/25/19.

Superior Capsular Reconstruction

Question:

What CPT codes do I use for comparison when the surgeon performs a superior capsular reconstruction? I know I have to use an unlisted code.

Answer:

Great job in knowing that this procedure is reported with an unlisted code. The AAOS recommends comparing this procedure to CPT codes 29827 and 29806.  Remember, the unlisted code is reported on the claim form; it is important to notate box 19 of the claim form the name of the procedure and the comparison codes for the unlisted code, 29999.

*This response is based on the best information available as of 07/11/19.

Coding TCAR

Question:

What is TCAR and how is it coded?

Answer:

TCAR stands for Transcarotid Artery Revascularization.  It is essentially an open carotid stent procedure. A small incision is made just above the collar bone to expose the common carotid artery. A sheath is placed directly into the carotid artery and connected to flow reversal system, for embolic protection. A stent is placed via that incision to treat carotid occlusion.

This procedure is reported as 37215,Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection.

*This response is based on the best information available as of 06/20/19