ICP Monitor and EVD Placed on Both Sides

Question:

We placed an ICP monitor on the left side of the cranium and a right ventriculostomy, both using the twist drill. We know to use CPT 61107 but wondered about using modifier 50 (bilateral procedure). Thoughts?

Answer:

Medicare does not recognize modifier 50 on 61107, though some payors might or may even recognize using HCPCS II modifiers RT (right) and LT (left). We suggest you report 61107 and 61107-59 (or modifier XS) just to be clear that the same CPT code was performed on either side of the head.

*This response is based on the best information available as of 10/29/20.

SI Joint Injection Help

Question:

My physician performed an SI joint injection in the ASC under ultrasound guidance and wants to bill 27096 and 76942. Is this correct? The description of the codes say imaging is included.

Answer:

No, this is not correct; you are correct to catch the inclusion of the imaging statement.

CPT code 27096 is defined as includingfluoroscopic or CT guidance, but not ultrasound (Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed).

Per CPT guidelines, if ultrasound is used instead of fluoroscopy or CT, report a trigger point injection code 20552 (Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)) and 76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation). CPT code 20552 is reported one time, whether the procedure is performed as a unilateral or bilateral procedure. Remember, CPT code 76942 has a professional and technical component; in the ASC setting you will append modifier 26 assuming the procedure note includes the required documentation for US guidance.

In answer to your question based on the ASC place of service, assuming documentation and medical necessity are present, the correct codes are:2055276942-26

If the procedure is performed in the office setting and you own the equipment, you may report 76942 without a modifier if the documentation supports the service.

Note: Some payor policies may deny payment of the US guidance ( CPT code 76942) with CPT code 20552.

*This response is based on the best information available as of 10/29/20.

Bjork Flap Tracheostomy

Question:

What would the correct CPT code be for a tracheostomy performed using a Bjork flap? I see some people stating it should be 31610. However, a Bjork flap is technically not a skin flap. I thought CPT 31610 was more for when a permanent stoma is created.

Answer:

CPT 31600 is the correct code for a Bjork flap tracheostomy. You are correct that 31610 is for a permanent tracheostomy where skin flaps are used to create a permanent stoma.

*This response is based on the best information available as of 10/15/20.

Elective Cranioplasty after Emergent Hemicraniectomy

Question:

I did an emergency craniectomy on a stroke patient 4 months ago. It is now time to reconstruct the defect and I’ll be doing that by placing some mesh and screws with Methyl methacrylate. Should I be using the 62140/62141 code series?

Answer:

Actually, CPT considers what you are doing to be “Replacement of bone flap or prosthetic plate of skull” which is 62143. You would still use 62143 even if you reconstructed the defect with the patient’s own bone flap that was stored at the bone bank or with an alloplastic implant designed for the patient.

*This response is based on the best information available as of 10/15/20.

Subacromial Decompression (29826)

Question:

Our surgeon frequently documents in the procedure title that an arthroscopic subacromial decompression was performed.  We are billing 29826 and are receiving denials from one particular payor stating that the documentation does not support the service.  I am looking at the operative notes associated with these denials and see that in none of the cases did the surgeon document any bony work. Is this required to report this code?

Answer:

Thank you for sharing your experience.  We heard of these denials years ago, so we appreciate  your sharing this information that a payor is again looking  at this code for supportive documentation.  To answer your Question:, yes, CPT code 29826 includes work on the acromion.

Note in the CPT code description, partial acromioplasty is listed as part of the procedure;  this is the ‘bony work’ in your inquiry.

29826  Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (List separately in addition to code for primary procedure)

Soft tissue work alone does not meet the definition of this CPT code. Typically, we see documentation similar to ‘an acromioplasty was performed  and reshaped to a type 1 acromion.’ This type of documentation will support the required work for the acromioplasty.  Removal of osteophytes or co-planing of the acromion does not support the partial acromioplasty requirement.

*This response is based on the best information available as of 10/15/20.

Billing for “Icy Green” Dye

Question:

The surgeon did a robotic/laparoscopic cholecystectomy and cholangiogram with icy green and firefly identification of biliary anatomy. He billed a 47563.  Can he can bill separately for the icy green and firefly dye?

Answer:

Billing for indocyanine (ICG) or Firefly TM fluorescence is bundled into 47563 laparoscopic cholecystectomy with cholangiogram and is not separately billable.

*This response is based on the best information available as of 10/15/20.