Modifier Order on CMS Claim Form

Question:

We are submitting a hospital claim form with the modifier 25 and FS modifier. We are unsure which modifier to list first. What is your recommendation?

Answer:

Thanks for contacting KZA and remembering to use the FS modifier for shared services provided in the hospital. KZA recommends placing modifier 25 first, as this is considered a reimbursement modifier followed by the FS modifier, which is an informational modifier.

Chemodenervation with Needle Electromyography

Question:

My doctor performed chemodenervation on all four extremities using needle electromyography. We use CPT code 95874 for the electromyography. My question is do I only report CPT 95874 once for all 4 extremities or can I report 95874 it for each extremity. Do I need to add Modifier 59?

Answer:

Yes, you can report needle electromyography with chemodenervation for each extremity. However, report only one guidance code per chemodenervation code.

Somatic Nerve Injections

Question:

When reporting an injection of a steroid of the brachial plexus can I report imaging such as ultrasound guidance?

Answer:

CPT code 64415 is reported for a injection of an anesthetic agent and/or steroid of the brachial plexus. Per CPT imaging guidance is included in the code and cannot be reported with CPT codes 76942, 77002 or 77003.

Coding for Trigeminal Neuralgia

Question:

How is RFA rhizotomy of the trigeminal nerve at the second and third division branches of the foramen ovale? The diagnosis was Trigeminal Neuralgia

Answer:

This procedure is coded as 64605,Destruction by neurolytic agent, trigeminal nerve second and third division branches at foramen ovale.Code +77002 may also be reported if fluoroscopy is used, documented, and a permanent image is retained.

SI Joint Injection

Question:

What CPT code do we use when our physician performs an SI joint injection using ultrasound guidance? CPT code 27096 states with fluoroscopy or CT guidance.

Answer:

CPT instructs to report CPT code 20552 for unilateral or bilateral SI joint injections if CT or Fluoroscopic imaging is not used. CPT code 76942, for the ultrasound guidance, may be reported if the documentation requirements are met.

What Does “Separate Procedure” Mean in a CPT Code Description?

Question:

What does “separate procedure” mean when it follows a CPT code description?

Answer:

Per CPT :Some of the procedures or services listed in the CPT codebook that are commonly carried out as an integral component of a total service or procedure have been identified by the inclusion of the term “separate procedure.” The codes designated as “separate procedure” should not be reported in addition to the code for the total procedure or service of which it is considered an integral component.

However, when a procedure or service that is designated as a “separate procedure” is carried out independently or considered to be unrelated or distinct from other procedures, report the code in addition to other procedures/services by appending modifier 59 to the specific “separate procedure” code. This indicates that the procedure is not considered to be a component of another procedure, but is a distinct, independent procedure. This may represent a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries).

What does this mean in practice?
If a code description includes the term “separate procedure”, if that procedure is in the same anatomic area as a more comprehensive procedure (for example, lyse of adhesions followed by a colectomy) only the more comprehensive procedure, the colectomy, is reported.