Ultrasound Guidance for Vascular Access

Question:

What are the requirements to code 76937 for ultrasound guidance for vascular access? 

Answer:

CPT code 76937 requires documentation of the following: ultrasound evaluation of potential access sites, localization and documentation of vessel patency, and the permanent recording and report must be noted and stored. ​

*This response is based on the best information available as of 10/03/24.

Paraspinal Intramuscular Injections

Question:

The type of injections our physicians perform are best described as paraspinal intramuscular injections or paraspinal nerve blocks without radiographic guidance. We are unsure how to code this procedure. What is the best code to use?

Answer:

Any injection around the spine without imaging guidance is best described as a trigger point injection.  The number of muscles injected determines whether CPT code 20552 (1 or 2 muscles) or CPT code 20553 (3 or more muscles) is billed.  If one muscle is injected multiple times, it should be coded with the lower code 20552.

*This response is based on the best information available as of 9/16/24.

Fall Risk Prevention Program: Part 2

Question:

We read and received your recent Coding Coach on the Fall Risk Prevention Program and directive to report Category II CPT codes for this service. We have a follow-up question.  Why would we not be able to report CPT code 97750 for this service, and can this code be billed incident-to the physician if the MA performs the work?   

Answer:

Per CPT coding guidelines, many parameters are associated with reporting CPT code 97750. CPT code 97750 is not used for a MIPS tracking code. Reporting this code requires that the work be performed by an MD, DO, or PT. An MA may not perform the work associated with this code and bill incident - to, as an MA is not a Qualified Healthcare Professional (QHP). 

*This response is based on the best information available as of 9/16/24.

Choosing the correct code for Nerve Conduction Studies (NCS)

Question:

When coding for nerve conduction tests, how are sensory, motor with or without F-wave, and H-reflex studies counted for nerve conduction tests?

Answer:

Nerve conduction studies are performed by placing electrodes directly over the motor point of the specific muscle to be tested and/or electrodes placed over the specific sensory nerve to be tested. H-reflex studies involve both the motor and sensory nerves and assess their connections in the spinal cord.

For the purposes of coding, a single conduction study is defined as a sensory conduction test, a motor conduction test (with or without an F wave test), or an H-reflex test.

Each type of study (sensory, motor, H reflex) for each nerve includes all impulses associated with that nerve and is counted as a distinct study when determining the number of studies billed.

Each type of study is counted only once when multiple sites on the same nerve are stimulated and recorded. The number of tests (sensory, motor, H reflex) per nerve should be added to determine the code to be billed.

CPT Appendix J contains a listing of motor and sensory nerves with each nerve counting as 1 unit of service.

*This response is based on the best information available as of 9/16/24.

Polydactyly Excision

Question:

We have a new surgeon in our practice who does hand surgery. I usually don’t code for hand surgery and have never coded a case before for polydactyly excision; how does one code this procedure? The documentation does not reflect any bony work.

Answer:

Within the hand section of the CPT book, you will find CPT code 26587. This code is for the reconstruction of polydactylous digit, soft tissue, and bone. Below this, there is a parenthetical note that states that for excision of polydactylous digit, soft tissue, only use CPT 11200. The documentation within the note will lead you to the appropriate code to report. Based on your scenario presented, CPT 11200 is applicable.

*This response is based on the best information available as of 9/11/24.

E/M service with treatment of Psoriasis

Question:

A new patient came in with an itchy scalp and came into my office today with a flare-up of her psoriasis.  Her psoriasis was diagnosed by another physician about 6 months ago. The psoriasis is worsening in her hand, but her scalp is fairly clear.  She has been using over-the-counter medication, which has not helped.  After a lengthy discussion about her condition, we decided a steroid injection on her palm would be beneficial since her entire palm was covered with scaly patches. I performed an injection on her hand and reported 11900 (intralesional injection).  I also wrote her a prescription for a topical ointment and scalp oil to use when needed.  We also discussed light box treatment, but she wants to try a topical prescription.  My question is can I bill an E/M service with the procedure?  One of my other colleagues told me I could not.

Answer:

Since you are doing more than the evaluation for the injection (11900), yes, you can bill an E/M service.  There is an inherent E/M service included in every procedure, but you counseled the patient, offered alternative treatment options, and prescribed prescription drug medications to the patient.  In this instance, the service does qualify for a significant separately identifiable E/M service with Modifier 25.  Based on the complexity of the problem addressed, which is chronic and not at treatment goal, and you prescribed prescription drug medication, you should report CPT codes 99204-25, 11901 and the J code for the medication injected.

*This response is based on the best information available as of 9/11/24.