Coding for ICG Imaging

Question:

Can you give guidance on CPT 15860 as it pertains to colorectal surgery?

My surgeons have been using this code when they use the isocyanine green fluorescence imaging either with the robot (Firefly) or open (SpyPhi).  They are saying this code is relevant because they are assessing vascular flow in a graft (it’s technically a graft of autologous tissue to replace the removed bowel).

Answer:

The infusion of ICG dye as imaging to assess perfusion is inherent to the procedure and not separately reported.

*This response is based on the best information available as of 12/19/19.

Coding for Percutaneous Tracheostomy

Question:

What code is used for percutaneous tracheostomy?

Answer:

Code 31600 is reported for “percutaneous” tracheostomy. This procedure is performed with a small incision and some direct visualization of the structures with or without a bronchoscope. The bronchoscope, used as a light source and to remove blood and secretions, isNOTseparately reported.

*This response is based on the best information available as of 09/19/19.

Code +15777 for placement of a non-biologic implant. Is this the correct code?

Question:

I placed a non-biological implant for abdominal soft tissue reinforcement. Can this be coded as +15777?

Answer:

No. Code +15777 is reported specifically for abiological implantfor soft tissue reinforcement implant in breast or trunk only. Code +0437T, a Category III code, is reported for implantation of anonbiologic or synthetic implant(eg, polypropylene) for fascial reinforcement of the abdominal wall. A Category III code is intended as a temporary or tracking code, and payment is carrier determined. Payors may consider Category III codes to be investigational and therefore not covered. To increase chance of payment, have always have the procedure pre-authorized.

*This response is based on the best information available as of 08/22/19.

Reporting a Cholecystectomy and an Umbilical Hernia at the Same Operative Session

Question:

If a patient undergoes an open cholecystectomy and has a reducible umbilical hernia repaired during the same operative session, through separate incisions, can both be reported?

Answer:

Yes, if both procedures were performed through separate incisions both may be reported. Conversely, if both were repaired through the same incision, only the cholecystectomy would be reported.

*This response is based on the best information available as of 08/08/19.

Billing for an iatrogenic injury, my patient.

Question:

The surgeon reported an intestinal perforation caused by a trocar during a laparoscopic cholecystectomy due to extensive adhesions.  He completed the cholecystectomy and also did a suture repair of one perforation of the small intestine. How is this reported?

Answer:

Iatrogenic, intraoperative complications that are repaired at the same operative session are not separately reported. Since the small bowel perforation was an iatrogenic injury, inadvertently done by the surgeon during a surgery, it is not reported. Only the cholecystectomy should be reported.

*This response is based on the best information available as of 06/06/19.

Peritoneal Catheter Placement

Question:

I placed the peritoneal catheter for a neurosurgeon placing a V-P shunt. Do I code 49419, insertion of peritoneal catheter?

Answer:

No, you are a co-surgeon with the neurosurgeon. Code 62223, creation of a ventriculo-peritoneal shunt, include both the neurosurgeon’s portion of placing the ventricular catheter and your portion of placing the peritoneal catheter. Both surgeon will report 62223-62.

*This response is based on the best information available as of 2/14/19.