Documentation for Modifier 22

Question:

What documentation is needed to report modifier 22?

Answer:

To be able to append modifier 22 which represents an increased procedural service, the provider needs to demonstrate that the work required was substantially greater than normally expected. To support this, the documentation must provide more than a blanket statement and include details as to why the work was greater. For example: “extensive lysis of adhesions took greater than 90 mins prior to reaching (the intended site)”.  The “what made it more work” is less crucial than the “details that explain why” it was more difficult so that payors will allow increased reimbursement. 

*This response is based on the best information available as of 7/11/24.

Microtia Surgery

Question:

What CPT code is appropriate for creating a cutaneous pocket fashioned for the framework for stage 1 of a microtia surgery? 

Answer:

The appropriate code for creating a cutaneous pocket in the context of stage 1 microtia surgery is CPT 14061 (adjacent tissue transfer).  This code corresponds to the procedure involving creating a cutaneous pocket in the right ear and transferring. The cutaneous pocket is essential for accommodating the framework created during reconstruction.  Since the code is selected based on anatomic location and sq centimeter size be sure to document this information in the operative report. 

*This response is based on the best information available as of 7/11/24.

Coding For Arthroscopic Subacromial Decompression

Question:

We received a denial from one of our payors saying the documentation did not support CPT code 29286. The surgeon documented bursectomy, release of ligament and removal of anterior osteophytes. Does this support CPT code 29826? 

Answer:

Thank you for your inquiry. Unfortunately, the payor is correct. The removal of osteophytes with or without the bursectomy and ligament release does not support CPT code 29826. To report the subacromial decompression, documentation must support an acromioplasty, which is a reshaping of the acromion. Typically, surgeons will document the work and state they took the acromion from a Type III to a Type I.  

*This response is based on the best information available as of 7/11/24.

Removal of Ventricular Catheter

Question:

What code would be used for removal of a ventricular catheter?

Answer:

There is no code for ventricular catheter removal, it is included in the placement as it is expected to be removed.

*This response is based on the best information available as of 7/11/24.

Transcutaneous Magnetic Nerve Stimulation

Question:

How is this service reported, we are having trouble locating a CPT code, should we use an unlisted code?

Answer:

This service should not be reported with an unlisted code.New Category III codes were created in 2023 to report transcutaneous magnetic nerve stimulation of peripheral nerve by focused low frequency electromagnetic pulse with noninvasive electroneurographic localization. This new technology is used in the management of chronic pain following a traumatic injury. The treatment is repeated over several months. Injured nerve is localized using magnetic stimulation at the time of the initial treatment. The skin is marked with photographic record to facilitate rapid localization of the correct site for subsequent treatments and the appropriate amplitude of magnetic stimulation.  

Nerve conduction may be used as guidance to confirm precise localization of the injured nerve but is not separately reported as a diagnostic study. If a separate diagnostic nerve conduction study is performed prior to the decision to treat with transcutaneous magnetic stimulation, then it may be reported separately.  

• 0766T Transcutaneous magnetic stimulation by focused low frequency electromagnetic pulse, peripheral nerve, initial treatment, with identification and marking of the treatment location, including noninvasive electroneurographic location (nerve conduction location) when performed; first nerve  

• +0767T Each additional nerve (List separately in addition to code for primary procedure 

*This response is based on the best information available as of 7/11/24.

Micromatrix

Question:

I'm new to plastics coding and have seen a couple of cases in which Acell Micromatrix is being documented. I have conflicting recommendations on whether to report this with a code from the 1527x series in CPT.  However, I'm not confident with the advice.   I am seeking an expert opinion and realize I should have started with KZA. Two questions:  1) is this separately reportable and 2) if yes, is CPT code 15271 the correct code?

Answer:

No, this is not separately reportable according to CPT Guidelines in the treatment of open wounds. Acell Micromatrix is a micronized particle (powder) and is considered a non-graft wound dressing. The CPT Guidelines for skin substitute grafts (page 100 of the 2024 CPT manual) instruct you to use the codes for biological products that form a sheet scaffolding to promote skin growth.   CPT instructs the skin substitute codes are not to be used for non-graft dressings such as the Acell Micromatrix, a powder.  KZA appreciates your inquiry as these codes are always under scrutiny. If you are in the office setting (non-facility) and purchased the Micromatrix, you may look to report HCPCS code Q4118 for the supply purchased and the application of the non-graft wound dressing would be captured in the appropriate evaluation and management level code.

*This response is based on the best information available as of 7/11/24.