Mastoidectomy Code Question

Question:

Is it ok to code 69641, 69642, and 69643 for procedures performed on the same ear at the same operative session?

Answer:

Absolutely not.  Use only one CPT code – whichever represents the procedure performed.

*This response is based on the best information available as of 12/05/19.

Periacetabular Osteotomy

Question:

We have a new pediatric orthopaedic surgeon who has joined our practice. He recently performed periacetabular osteotomies for hip dysplasia. He wants us to report CPT codes 27228 and 27146 x3 for this procedure based on information he received during his fellowship training. We have told him that we must report an unlisted CPT code. Will you advise if we can report the codes he suggests, or is the unlisted CPT code correct?

Answer:

There are two options to report this service based on whether the payor follows Medicare rules or not:

• From a CPT standpoint, the correct Category I CPT code is 27299 (Unlisted procedure, pelvis or hip joint).
• A Level III HCPCS code exists (S2115 Osteotomy, periacetabular, with internal fixation) for payors who recognize S codes; Medicare does not recognize these level three codes. These codes were commonly referred to as “local codes” and are not published in the CPT manual.

CPT code 27228 (Open treatment of acetabular fracture(s) involving anterior and posterior (two) columns, includes T-fracture and both column fracture with complete articular detachment, or single column or transverse fracture with associated acetabular wall fracture, with internal fixation) is incorrect, as the physician is not treating a fracture.

CPT code 27146 (Osteotomy, iliac, acetabular or innominate bone;) is also incorrect, as the surgeon is not performing a single osteotomy of any one of these bones; the surgeon is performing multiple osteotomies, or cuts in the acetabulum.

*This response is based on the best information available as of 12/05/19.

Coding Bilateral Percutaneously Placed Spinal Cord Stimulator Electrodes

Question:

If bilateral spinal electrode are placed percutaneously, 63650, can both be reported?

Answer:

Yes, if two electrodes are placed, bilaterally, both may be reported.  See the CPT guidelines below.

Reference: CPT Assistant June 1998

Codes 63650, 63655, and 63660 each describe the placement, revision, or removal of only one electrode catheter or electrode plate/paddle. Placement of any additional electrode catheter(s) or plate(s)/paddle(s) should be separately reported by appending the modifier -51 to the appropriate code.

*This response is based on the best information available as of 12/05/19.

Binocular Microscopy

Question:

I oftentimes bill and E/M code with modifier 25 for an office visit and 92504-50 (1 unit) for the binocular microscopy to Medicare.  I get denied on 92504-50 but I am paid on 99212. The denial code is “CO-4 The procedure code is inconsistent with the modifier used or a required modifier is missing” and “M20 Missing/incomplete/invalid HCPCS” or “N519 Invalid combination of HCPCS modifiers.”  Then Medicare says no appeal rights are afforded because the claim is unprocessable and I should submit a new claim with the complete/correct information. I don’t understand what’s wrong.  Please help.

Answer:

What’s wrong is that modifier 50, for bilateral procedures, should not be appended to 92504. CPT 92504 is reported only once without modifier 50.  Additionally, you probably don’t need modifier 25 on the E/M code to Medicare because there is not a National Correct Coding Initiative (NCCI) edit between the two codes which would warrant modifier 25.

*This response is based on the best information available as of 11/14/19.

Definition of Simple versus Complicated

Question:

What is the definition of simple vs complicated for the I&D codes 10060 versus 10061?

Answer:

While CPT doesn’t define the difference between “simple” and “complicated”, it is the accepted practice that a simple I&D 10060 is just that. An incision (not just a puncture) is performed, and the abscess is left open to drain and heal. A complicated I&D 10061 would usually require one or more of the following: multiple incisions, probing to break up loculations, extensive packing, drain placements, and wound closure. If documentation isn’t clear on what exactly was performed, ask the provider for guidance as the reimbursement difference with these codes is fairly significant.

*This response is based on the best information available as of 11/14/19.

Shunt Revision

Question:

I had to replace the ventricular catheter and the valve on a patient with a VP shunt.  What code should I use?

Answer:

Actually you get two codes!  CPT 62225 is used for the ventricular catheter replacement and 62230 for the valve replacement.  Both codes are appropriate in this scenario.

*This response is based on the best information available as of 11/14/19.