Hematoma I&D with Fasciotomy

Question:

Our surgeon performed an I&D of a hematoma in the same compartment as an anterior and lateral fasciotomy in the leg for compartment syndrome. I submitted a code for the I&D in addition to the fasciotomy code and the surgeon removed the I&D code, stating it would be inclusive to the fasciotomy. I don’t feel this is correct. Is the I&D inclusive?

Answer:

KZA agrees with the surgeon based upon the information presented in your scenario. The drainage of a hematoma in the same compartment(s) as the fasciotomy is inclusive to the fasciotomy code(s).

*This response is based on the best information available as of 10/03/19.

Reporting 75630 with Extremity Angiograms

Question:

Can code 75630, aortogram, be reported with a unilateral or bilateral extremity angiogram (75710 of 75716)?

Answer:

No. This would constitute double billing of the extremity angiograms.  As shown below, code 75630 includes an aortogram and visualization and interpretation of bilateral lower extremity arteries via a run-of.  For this code, a catheter is advanced to the infra-renal aorta and, without moving the catheter farther down the aorta or in one of both extremities, a run-off of contrast provides imaging of the both extremities to include the iliac and femoral arteries.

Code 75625 is for an aortogram, only. Code 75710 or 75716 is reported in addition to 75625 if the catheter is moved to the aorta bifurcation or into one of both extremities, providing additional imaging of one or both legs.

75630

Aortography, abdominal plus bilateral iliofemoral lower extremity

75625	Aortography, abdominal, non-selective
75710	Angiography, arm/leg(Unilateral)
75716	Angiography, arm/leg(bilateral)

*This response is based on the best information available as of 10/03/19.

Artificial Cervical Disc Placement

Question:

We are just starting to do these procedures and I want to get our coding sorted out. We will be doing a cervical discectomy with decompression under fluoroscopy and implanting the artificial disc. We think the correct codes are: 22551(anterior cervical discectomy and decompression), 22856 (total disc arthroplasty) and 76000 (fluoroscopy). Are we right?

Answer:

How exciting to add a new procedure to the practice! And, kudos for being proactive about the coding. Actually, CPT 22856 includes the discectomy, decompression and placement of the implant. Additionally, it would not be accurate to separately report 22551 because an arthrodesis (also included in 22551) is not performed in this procedure. Lastly, fluoroscopy (76000) is included in all open spine surgical procedure codes and not separately reported. Therefore, 22856 covers the entire procedure for a one-level total disc arthroplasty. CPT +22858 would be used for the second level if performed.

22856 Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); single interspace, cervical

*This response is based on the best information available as of 10/03/19.

Coding for Percutaneous Tracheostomy

Question:

What code is used for percutaneous tracheostomy?

Answer:

Code 31600 is reported for “percutaneous” tracheostomy. This procedure is performed with a small incision and some direct visualization of the structures with or without a bronchoscope. The bronchoscope, used as a light source and to remove blood and secretions, isNOTseparately reported.

*This response is based on the best information available as of 09/19/19.

New FNA Codes and Diagnostic Ultrasound

Question:

I understand that the new FNA with ultrasound code, 10005, includes the ultrasound guidance for the FNA.  But, can we also charge 76536?

Answer:

Yes, if you have performed a separate diagnostic ultrasound to support 76536.  Remember, this is a radiology code. So if you are reporting 76536 without any modifiers (modifier 26-professional component or modifier TC for technical component) then you are billing for the diagnostic ultrasound interpretation like a radiologist would. Therefore, there must be a separate radiologic supervision and interpretation note for the diagnostic ultrasound.  This note would stay with the diagnostic study and be provided with the diagnostic study images if ever requested by the patient or someone else.

*This response is based on the best information available as of 09/05/19.

Code +15777 for placement of a non-biologic implant. Is this the correct code?

Question:

I placed a non-biological implant for abdominal soft tissue reinforcement. Can this be coded as +15777?

Answer:

No. Code +15777 is reported specifically for abiological implantfor soft tissue reinforcement implant in breast or trunk only. Code +0437T, a Category III code, is reported for implantation of anonbiologic or synthetic implant(eg, polypropylene) for fascial reinforcement of the abdominal wall. A Category III code is intended as a temporary or tracking code, and payment is carrier determined. Payors may consider Category III codes to be investigational and therefore not covered. To increase chance of payment, have always have the procedure pre-authorized.

*This response is based on the best information available as of 08/22/19.