Blood Patch with Epidural

Question:

My anesthesiologist had to perform a blood patch on a patient who received an epidural the day before. Can we bill for this?

Answer:

It depends. If the patch was performed through the same catheter for the epidural, then this would not be separately billable. However, if the blood patch was performed as a new injection into the epidural space, then it would be separately billable with CPT 62273.

*This response is based on the best information available as of 06/25/20.

Excision External Ear

Question:

I did a partial excision of the left ear wedge with a layered closure. Can I code 69110 and a complex repair code since 69110 says “simple repair”?

Answer:

CPT 69110 includes the direct closure (bringing wound edges together) because it says “simple repair” so that would include a simple, intermediate or complex repair code. We would not recommend a separate repair code in the circumstance you describe.

*This response is based on the best information available as of 06/25/20.

Intraoperative Laryngeal Nerve Monitoring with Thyroidectomy Procedures

Question:

Are we able to bill for laryngeal nerve monitoring with thyroidectomy procedure?

Answer:

No – CPT is very clear in that intraoperative monitoring (e.g., 95940, 95941) is included in the global surgical package for the surgeon and should not be separately reported.

*This response is based on the best information available as of 06/11/20.

Seroma after Breast Reconstruction

Question:

During the post-operative global period following breast reconstruction the patient presents with a seroma. Can I bill for the seroma excision and also bill for an office visit since it is a new problem?

Answer:

Medicare says treating the patient for issues related to the procedure, such as a seroma, are not separately payable unless they require a return to the operating room (modifier 78). There is not a modifier for “return to the office to treat a surgical complication.”

Check your other payors for their rules – in the absence of a specific payor rule allowing payment for treating complications in the office, we typically recommend you not bill. And, don’t forget, if you bill then the patient will have a co-pay.

*This response is based on the best information available as of 06/11/20.

Coding a Diverting Ileostomy with a Low Anterior Resection/Low Pelvic Anastomosis Partial Colectomy

Question:

Instead of a colostomy as described in the laparoscopic CPT codes 44208 or the open code, 44146, my doctor does a diverting ileostomy. We have been billing the primary codes 44145 or 44207 and adding the ileostomy code, 44187 if laparoscopic or 44310 if open. Is that correct?

Answer:

Partial colectomy with anastomosis and colostomy (codes 44146, open or 44208, laparoscopic) includes creation of a colostomy (stoma of the large intestine) or ileostomy (stoma of the small intestine). The clinical description of this code, written when the code was developed, describes either external opening, so the codes are valued to include either an ileostomy or colostomy. So the correct coding is 44146 or 44208 when a low anterior resection/low pelvic anastomosis partial colectomy and a diverting ileostomy is performed instead of a colostomy.

For more information on colorectal coding, take a look at the KZA webinarColorectal Surgery Coding and Reimbursement, or contact us for more information.

*This response is based on the best information available as of 6/11/20.

Genicular Nerve RFA

Question:

I’m new to coding. What code would I use for radiofrequency ablation of the genicular nerve?

Answer:

You’re in luck! There is a new code in 2020: 64624 Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed. The code includes destruction (e.g., chemical means, radiofrequency ablation) of all branches of the genicular nerve including the the superolateral, superomedial, and inferomedial genicular nerves. CPT 64624 also includes fluoroscopic/imaging guidance so you would not report a separate radiology code (7xxxx).

*This response is based on the best information available as of 05/29/20.