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VP Shunt Re-programming During a Global Period
What if we have to re-program a VP shunt during the global period because the settings need to be adjusted – can we bill for it or is it considered part of the 90-day post-operative
Question:
What if we have to re-program a VP shunt during the global period because the settings need to be adjusted – can we bill for it or is it considered part of the 90-day post-operative global period?
Answer:
Good Question:. The initial shunt programming, at the time of insertion, is included in the shunt placement code (e.g., 62223). However, subsequent shunt re-programming is not included. Therefore, you may separately report 62252 (Reprogramming of programmable cerebrospinal shunt) for the shunt re-programming even if you are in a global period. You may need to append modifier 58 to 62252 as it would be anticipated re-programming is needed if the patient’s condition changed.
*This response is based on the best information available as of 8/20/20.
Spine Fracture Repair and Decompression
How do I code for repair of a C6-7 fracture/dislocation where I did a laminectomy for decompression to repair the fracture as well as an arthrodesis?
Question:
How do I code for repair of a C6-7 fracture/dislocation where I did a laminectomy for decompression to repair the fracture as well as an arthrodesis?
Answer:
You’ll use CPT 22326 (Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; cervical) for the open cervical fracture/dislocation repair. Additionally, you may report codes for the arthrodesis (e.g., 22600), instrumentation (e.g., +22840) and bone graft (e.g., +20936). Do not separately report a decompression code (e.g., 63001) for the laminectomy at the same level of the fracture repair procedure (22326).
*This response is based on the best information available as of 8/6/20.
Hartmann or Partial Colectomy
My surgeon performed all the components of a Hartmann procedure 44143 but did not create a colostomy. Can we use 44143 with a -52 modifier?
Question:
My surgeon performed all the components of a Hartmann procedure 44143 but did not create a colostomy. Can we use 44143 with a -52 modifier?
Answer:
The correct code for this procedure would be 44140. Code 44140 is the base code for 44143 with the only difference being a skin level colostomy, so it would be inappropriate to code 44143-52 as there is an established code already in place.
*This response is based on the best information available as of 8/6/20.
Sphenopalatine Ganglion Block
I cannot find a CPT code to report using a device to deliver medication through the nose when a sphenopalatine ganglion block is performed under fluoroscopic guidance for patients with…
Question:
I cannot find a CPT code to report using a device to deliver medication through the nose when a sphenopalatine ganglion block is performed under fluoroscopic guidance for patients with migraine headaches. Can you provide me with the correct CPT code?
Answer:
There is no specific CPT code that accurately describes this service. The code set includes code 64505, which describes the injection of the sphenopalatine ganglion. However, it is inappropriate to report this code since an injection is not performed. Therefore, the unlisted code 64999, Unlisted procedure, nervous system, should be reported.
*This response is based on the best information available as of 08/06/20.
Carotid Artery Exploration with Free Flap to Oral Cavity
Can we report 35701 for the carotid vessel exploration in the recipient site when doing a fibula free flap (20969)?
Question:
Can we report 35701 for the carotid vessel exploration in the recipient site when doing a fibula free flap (20969)?
Answer:
No, this activity is included in the free flap code. CPT specifically states not to 35701 to explore and identify a recipient artery [eg, external carotid artery] when performed in conjunction with free flap codes including 15756, 15757, 15758 and 20969.
*This response is based on the best information available as of 07/23/20.
Complex Closure of Free Flap Donor Site
I did a right anterolateral thigh free flap and had to close the right thigh wound (4 x 8 cm) with undermining of additional 3 cm in either direction to close the wound without any significant…
Question:
I did a right anterolateral thigh free flap and had to close the right thigh wound (4 x 8 cm) with undermining of additional 3 cm in either direction to close the wound without any significant tension. Can I also code a complex repair (13100, +13101) with the free flap code?
Answer:
Bringing the wound edges directly is included in the free flap code. However, CPT says that repair of donor site requiring skin graft or local flaps (e.g., adjacent tissue transfer requiring a separate skin incision to create a secondary defect) may be separately reported. Additionally, Medicare has a National Correct Coding Initiate (NCCI) edit between the free flap codes and the complex repair codes which could not be overridden because the procedures are in the same area. So, no, a complex repair code would not be used for closure of the flap donor site.
*This response is based on the best information available as of 07/09/20.
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