Lower extremity revascularization

Question:

When coding lower extremity re-vascularization procedures, can the tibial-peroneal trunk, posterior tibial and anterior tibial arteries all be coded separately? 

Answer:

The tibial peroneal trunk (TPT) splits into the peroneal and posterior tibial (PT) arteries. The anterior tibial artery branches off the popliteal artery above the tibial peroneal trunk.  Therefore, when coding, the anterior tibial artery is considered separate from the TPT; however, the PT is considered a continuation of the TPT and not a separately coded vessel. So, if the anterior tibial, the posterior tibial, and the peroneal arteries are all treated, for example, with atherectomy, each may be separately reported.

*This response is based on the best information available as of 9/9/24.

Splanchnic Nerve Injection

Question:

We are unsure what CPT code to use when our physician injects the splanchnic nerve with phenol. Is this an unlisted CPT code? 

Answer:

Since the splanchnic nerve is part of the celiac plexus, and phenol is a neurolytic agent, you should report CPT code 64680, Destruction by neurolytic agent, celiac plexus, with or without radiologic monitoring. (For an injection of other substances such as an anesthetic and/or steroid, not a neurolytic agent, use code 64530 Injection, celiac plexus).

*This response is based on the best information available as of 9/9/24.

Fall Risk Prevention Program: Part 1

Question:

We want to institute a Fall Risk Prevention Program in our practice to take advantage of CMS's Merit-based Incentive Payment System (MIPS). Based on CMS’s 2024 Quality Measures List, what codes should we report, and can our practice's medical assistant (MA) capture this work? 

Answer:

It is great that your practice will institute a Fall Risk Prevention Program to capture MIPS. According to CMS’s 2024 Quality Measures list, there are 2 measures reportable in this category. 

Quality measure number 155 - Falls: Plan of Care. This measure is designed to capture the percentage of patients aged 65 years and older with a history of falls who had a plan of care for falls documented within 12 months. 

Quality measure number 318 – Falls: Screening for Future Fall Risk. This measure is designed to capture the percentage of patients 65 years of age and older screened for future fall risk during the measurement period. 

Per CPT, these quality measures should be reported with Category II tracking codes, which are used for performance measurement. 

The applicable category II CPT codes for these MIPS measures are as follows: 

• 1100F: Patient screened for future fall risk; documentation of 2 or more falls in the past year or any fall with injury in the past year (GER). 

• 1101F: Patient screened for future fall risk; documentation of no falls in the past year or only 1 fall without injury in the past year (GER). 

An MA can capture the work to assist the clinician when reporting these Category II CPT codes. 

*This response is based on the best information available as of 9/5/24.

Neck Dissection

Question:

My physician did a total thyroidectomy with a modified radical neck dissection.  Can I report the radical neck dissection with the thyroidectomy?

Answer:

If your physician performed the total thyroidectomy using CPT code 60240 and modified radical neck dissection (38724), both procedures may be reported during the same operative session.  The first listed code on the claim should be CPT 38724. Modifier 59 should be appended to CPT code 60240 (lower RVU) since it is bundled under the National Correct Coding Initiative.

*This response is based on the best information available as of 9/5/24.

Moderate Sedation

Question:

Can our vascular surgeon bill for moderate sedation if an RN was present to observe and monitor the patient?

Answer:

Yes; an RN has the knowledge and experience to observe and monitor the patients vital signs, including BP, oxygen levels, heart rate and level of consciousness under the direct supervision of the physician.

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

Evaluation and Management (E/M)

Question:

We had a new patient who came in for evaluation for itchy skin eruptions that had never been treated. He documented a complete history and full skin examination and diagnosed the patient with psoriasis, which was inadequately controlled, and performed an intralesional injection (11900) in the patient’s hand, which was the area of concern.  He found psoriasis on the scalp, hand, and chest and wrote the patient a prescription for Clobetasol ointment and spray.  My question is, can we bill an E/M service with Modifier 25 since he did a complete history and skin exam? 

Answer:

The E/M services require a clinically relevant history and examination. This will not determine whether Modifier 25 is supported. What does support a significant separate E/M service is that in addition to the intralesional injection, the physician developed a plan of care that not only included the injection but also prescribed medication to treat the areas. An E/M service based on medical decision-making or time 99203-99205 (new patient) can be reported with modifier 25 in addition to CPT code 11900.

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