Selective or Non-Selective Catheterization

Question:

If we access the dorsalis pedis artery with a catheter and go up into the anterior tibial for arteriogram, is this selective or non-selective?

Answer:

This would be a non-selective catheterization; the access was made and did not cross into the aorta or into another territory for selective catheterization.

*This response is based on the best information available as of 6/19/25.

Flap Creation to Prevent Adhesion to Abdominal Wall

Question:

Can I separately bill for an omental flap or peritoneal flap when the surgeon performs the flap to prevent adhesion to the abdominal wall after a hernia repair or colon resection?

Answer:

No, you cannot bill separately for the omental or peritoneal flap. Using flaps to prevent adhesion to the abdominal wall is considered part of the closure and would not be separately reported.

*This response is based on the best information available as of 6/19/25.

Amount of Lamina Removed for a Laminectomy

Question:

I'm pretty new to neurosurgery coding and could use some help. Is there a specific amount or percentage of lamina that must be removed in order to code 63047?

Answer:

No. Surgeons usually try to remove as little lamina as possible – just enough to relieve pressure on the nerve. A specific amount does not need to be documented.

*This response is based on the best information available as of 6/19/25.

Performing Endoscopy at the Request of Another Provider

Question:

If another provider, asks that I perform an endoscopy prior to placement of a G- tube, and then the other provider places the G-tube via the endoscope, can I separately report my portion of the endoscopy?

Answer:

No.  Endoscopic placement of a G-tube (43246) includes the work of both the endoscopy and the placement of the tube.  However, you could bill as an assistant MD with modifier 80 or modifier 82 as appropriate, for your portion of beginning the endoscopy.

*This response is based on the best information available as of 6/05/25.

Instrumentation Removal vs. Exploration

Question:

My coder told me that if spinal instrumentation is removed and exploration performed but nothing else done, we would code for exploration but not for the removal of instrumentation.   Why wouldn't we bill instrumentation removal vs exploration?

Answer:

When spinal instrumentation is removed for the purpose of exploration, we would code the exploration CPT code 22830; the instrumentation removal is included in the exploration. 

*This response is based on the best information available as of 6/05/25.

Incident-To Billing for Medicare

Question:

I was told for our Medicare patients in order for my PA to report incident-to the physician, that the supervising physician must be in the office.  Is that correct?  We are billing new and established patients under a physician’s NPI number even if there is no physician in the office.

Answer:

To bill Incident-to services a physician must be in the office suite, but it does not need to be the Advanced Practice Provider’s (APPs) supervisor. In addition, you cannot bill incident-to for a new patient when the APP sees them. “Incident To” can only occur for an established patient with an established plan of care originally developed by a physician. If the plan of care changes or the patient has a new or worsening problem, it must be billed under the APP's NPI number. For Medicare, when billing under the APPs NPI number 85% is paid under the Medicare Physician Fee Schedule.

*This response is based on the best information available as of 6/05/25.