Coding for Vascularized Pericranial Graft

Question:

Can we code for harvest of vascularized pericranial graft during a left temporal craniotomy for resection of epidural abscess? If so what code should I use?

Answer:

No, that is not billable since it the graft was obtained through the same surgical exposure as the primary procedure.

*This response is based on the best information available as of 02/10/22.

Inpatient E/M Coding

Question:

I did an inpatient consultation and coded 99253 (non-Medicare). I did not need to follow the patient, so I signed off. They asked me to re-consult a week later. What is the code for a re-consult?

Answer:

There are no specific E/M codes for an inpatient re-consultation. You will use the subsequent hospital care code, 9923x, since it is the same admission for the patient.

Question:Follow up question: the patient was discharged then admitted a month later and I was consulted again. Is this a subsequent hospital care code?

Answer:

No, since it is a new admission for the patient, you will use the consultation code again (9925x).

Question:Last question: when I see the patient in my office a month later, is it a new patient?

Answer:

No, it is an established patient (9921x) because you have had a face-to-face visit with the patient in the previous 3 years.

Billing E/M Visits During the Global Period

Question:

Can I bill different diagnosis codes for conditions/problems when seeing a patient in the hospital after surgery, but during the stay of a major surgery?

Answer:

It depends. You cannot bill for related issues or known complications that arise from the surgery, but you can bill for unrelated conditions/problems with proper documentation that supports billing. It must be clear in the documentation that the condition is unrelated with a clear plan of treatment for the new/unrelated issue. You would need to add a modifier -24 to any unrelated E/M service performed.

*This response is based on the best information available as of 02/10/22.

Billing Additional Pre-op Visit

Question:

Since we have to bring the patients back in for COVID testing and H&P for Joint Commission, can we bill for this visit even though it’s another pre-op visit?

Answer:

Yes, the original surgery was canceled and is now under consideration for rescheduling due to the pandemic and the patient needs to be seen for a COVID swab prior to surgery. This health status change is the indication for the office visit.

OATS Procedure Humeral Head

Question:

Our surgeon will be performing an OATS procedure with allograft on the humeral head. Will you advise on what CPT code we should report?

Answer:

Thanks for your inquiry. There is no CPT code for this procedure. You will use an unlisted code based on the approach.

Report CPT code 24999,Unlisted procedure, humerus or elbowif the procedure is performed as an open procedure.

Report CPT code 29999,Unlisted procedure, arthroscopyif the procedure is performed arthroscopically.

CPT has category I codes for OAT with allograft in the knee (27415, 29867), and these could be considered for comparison.

Billing for Multiple Embolectomies

Question:

How do we code multiple embolectomies of the aorta when using 34201? Do we code units by the number removed?

Answer:

34201,Embolectomy or thrombectomy, with or without catheter; femoropopliteal, aortoiliac artery, by leg incisionis billed once per leg incision no matter how many emboli are removed from each incision. If this is performed bilaterally (two leg incisions), then bill 34201 with mod -50.