7th Character for Cast Re-application

Question:

We are a bit confused about what 7th character code we should use when the patient is being seen in follow-up for a fracture. The initial encounter was reported with the “7th character” for the initial evaluation and application of cast or splint. When the patient returns and the surgeon re-applies a new cast, do we use the 7th character code for active treatment or the 7th character code for routine healing?

Answer:

Thank you for your inquiry. You are not alone in your confusion even 8 years after ICD 10 was implemented. You are correct to use the “initial treatment” (sometimes referred to as the active treatment) code for the initial evaluation of the patient. If the treatment plan is to apply a cast, and the patient returns, they are stable, healing has begun, the correct 7th character code for the fracture will be the “routine healing or follow-up care.”

Other examples of when you might use the 7th character for routine healing/subsequent encounter, in addition to the cast/splint re-application, are:

· Dressing change or removal

· Staple or suture removal

· Removal of external or internal fixation device

Some of the confusion stems from references to “initial” treatment and “active” treatment.

ICD identifies the 7th character, based on the location and type of fracture, to be:

• Initial

• Routine

• Delayed

• Nonunion

• Malunion

*This response is based on the best information available as of 2/13/25.

Reporting An Unlisted CPT Code

Question:

What is needed to report an unlisted CPT code?

Answer:

To report an unlisted CPT code, you must first make certain that no code exists that represents the procedure in its entirety or with a modifier that would represent what was performed (e.g., modifier 52 for reduced services). Once it is determined that there is no existing code to represent the work, choose a code from the appropriate anatomical section of CPT, the appropriate approach (i.e. open vs laparoscopic), and compare the unlisted code to another code that most closely resembles the anatomical area, approach (if possible) and work involved to accurately compare RVUs and reimbursement expectations.

*This response is based on the best information available as of 2/13/25.

Stereotactic Navigation and Microscope

Question:

Our provider performed a craniotomy for 2 separate lesions, one parietal and one occipital, through two separate craniotomy exposures. Stereotactic navigation and the operating microscope were needed for both resections. We are coding for the separate lesions as 61510, 61510-59, but can we also bill 61781 and 69990 twice with modifier 59 since they were needed for each separate lesion? 

Answer:

 No, stereotactic navigation and the microscope can each only be billed once per operative session. 

*This response is based on the best information available as of 2/13/25.

Non-healing Wound ICD-10

Question:

Should ICD-10 T81.31X– be reported for non-healing healing wounds?

Answer:

Thank you for your great question!

It would not be appropriate to report a non-healing wound with ICD-10 T81.31X, as this code is for the disruption of a closed wound.

There is no straightforward way to look up the ICD-10 code for a non-healing wound, either! That is because there is no specific code.

In this instance, ICD-10 T81.89X– would be assigned for the non-healing wound.

*This response is based on the best information available as of 2/13/25.

Pericapsular Nerve Group (PENG) block

Question:

Prior to 2025 we had been instructed to code a Pericapsular Nerve Group (PENG) block to 64999?  What is the best CPT code for a PENG block in 2025?

Answer:

In this procedure, a local anesthetic is injected into the fascial plane located between the psoas tendon and the ilium. This targeted block affects the articular branches of the femoral, obturator, and accessory obturator nerves, which provide sensory innervation to the anterior capsule of the hip.

With the creation of the 2025 CPT codes:

• 64466 – Thoracic fascial plane block, unilateral; by injection(s), including imaging guidance, when performed

• 64467 – Thoracic fascial plane block, unilateral; by continuous infusion(s), including imaging guidance, when performed

• 64468 – Thoracic fascial plane block, bilateral; by injection(s), including imaging guidance, when performed

• 64469 – Thoracic fascial plane block, bilateral; by continuous infusion(s), including imaging guidance, when performed

• 64473 – Lower extremity fascial plane block, unilateral; by injection(s), including imaging guidance, when performed

• 64474 – Lower extremity fascial plane block, unilateral; by continuous infusion(s), including imaging guidance, when performed

CPT Codes 64473 and 64474 now represent the Pericapsular Nerve Group (PENG) block.  The code selection is based on whether an injection or continuous infusion is performed.

*This response is based on the best information available as of 2/13/25.

Skin Cancer Screening

Question:

What is the correct ICD-10-CM code for a skin screening exam for a patient who has a history of malignant melanoma?

Answer:

You should report 2 diagnosis codes; ICD-10-CM Z12.83 for the encounter for malignant neoplasm of skin and Z25.820 (personal history of malignant melanoma of skin).

*This response is based on the best information available as of 2/13/25.