XTRAC

Question:

Our practice is considering using XTRAC for patients with psoriasis. Before we purchase the laser, we want to make sure we get paid. Is there a CPT code for XTRAC?

Answer:

There is a CPT code for XTRAC, an excimer laser treatment for psoriasis. There are actually three codes: 96920, 96921, and 96922. The codes are selected by square centimeter size. CPT 96920 is reported for 250 square centimeters or less, 96921 when the total area treated is 250 to 500 square centimeters, and 96922 for treated areas over 500 square centimeters. The side of the treated area must be included for CPT codes that are reported based on centimeter or square cm size documentation.

*This response is based on the best information available as of 10/31/24.

Evacuation of Recurrent Subdural Hematoma and Drain Placement

Question:

A patient returns two weeks after evacuation of a chronic subdural hematoma with a recurrence requiring another evacuation of the hematoma and placement of a subdural drain. What are the correct codes to report for the evacuation of the hematoma and placement of the drain?

Answer:

CPT code 61312 for re-do craniotomy for hematoma with modifier 58 appended for a more extensive procedure treating the same problem during the global period.  The drain would not be separately reported.

*This response is based on the best information available as of 10/17/24.

Converting Dimensions

Question:

My surgeon placed integra and dictated the integra dimensions in inches instead of centimeters. Can the inches be converted into centimeters to determine code selection?

Answer:

Thank you for your inquiry.  

From a best practice standpoint, the physician is encouraged to document the size based on CPT requirements, e.g. centimeters in this scenario.  The risk is that an error may be made in performing the conversion if this activity is not regularly performed.

*This response is based on the best information available as of 10/31/24.

Use of Robotic Systems During Surgical Procedures

Question:

What is the code for a robotic procedure?

Answer:

When surgical procedures involve the use of robotic surgical systems, the robotic component can be represented by HCPCS code S2900.  However, there is no RVU associated with this code, and it is not reimbursed under the Medicare payment system.   The best practice is to set a fee for the extra physician work involved with robotic assistance, document medical necessity for the use of the robot, and incorporate this code into billing for tracking purposes when used.

*This response is based on the best information available as of 10/31/24.

Stratum Corneum

Question:

What CPT code do I use for the sampling of the Stratum Corneum?  I have searched everywhere and cannot find a code.

Answer:

The sampling of the stratum corneum by any method, is not a biopsy. Skin scraping or tape stripping is not considered a biopsy and should be credited as part of the E/M service.

*This response is based on the best information available as of 10/17/24.

Sphenopalatine Ganglion Block with Medication Delivery

Question:

One of our physicians is using a device to deliver medication through the nose when a sphenopalatine ganglion block is performed under fluoroscopic guidance for patients with migraine headaches.  Can we report 64505 for this service?  If not, what is the best code to report?

Answer:

 There is no specific CPT code that accurately describes the service.  The code set includes CPT code 64505, which describes the injection of the sphenopalatine ganglion; however, it is inappropriate to report this code since an injection is not performed. Therefore, the unlisted code 64999, Unlisted procedure, nervous system, should be reported. 

Another variation on blocking the sphenopalatine ganglion is using a Q-tip to apply anesthetic topically through the nose. There is no specific CPT code for this procedure, which is best reported as part of the E/M service. 

*This response is based on the best information available as of 10/17/24.