Repair of a Semi-Circular Canal Dehiscence with ENT

Question:

We are doing a combined case with ENT and are not sure how to code it. The patient has a semi-circular canal dehiscence of the temporal bone. ENT is going to do the approach and I’m going to do the repair of the defect with local bone. We will use mesh to reconstruct the cranial defect for closure. How do we code this procedure?

Answer:

It is difficult to provide exact CPT codes unless we see an operative note. That said, there is not a code for this exact procedure. An unlisted code will likely be necessary. Another thought is to use the exploratory craniotomy code, 61304, with modifier 62 (two surgeons).

*This response is based on the best information available as of 5/28/20.

Billing Telephone Calls Longer than 30 Minutes

Question:

We cannot locate a response from any reliable coding resource about how to bill telephone calls lasting more than 30 min. Do you have any guidance on this topic?

Answer:

Although telephone calls for both new and established patients are temporarily billable during the current COVID-19 public health emergency, there is not a way to bill for additional minutes over 30 for a phone call. Telephone calls (99441-99443) can only be billed at one unit a day andonly include the time for the billing provider talking to the patient, not staff time talking to the patient.

Although prolonged service codes are listed as billable for telehealth visits, telephone calls are not considered telehealth services, so prolonged service codes would not apply for billing to Medicare. However, commercial payors may have different billing flexibilities during this crisis, so you will want to check with your commercial payors.

*This response is based on the best information available as of 4/30/20.

Diagnosis Code for “End of Life” DBS Battery

Question:

What would be the appropriate diagnosis code (ICD-10-CM) for “end of life battery” when we have to change the generator in a deep brain stimulator patient. I have gotten mixed responses previously whether or not to bill “mechanical complication” vs “encounter for adjustment”. Or are both of these incorrect?

Answer:

We recommend using the original diagnosis for why the deep brain stimulator was placed in the first place (e.g., Parkinson’s). It is expected that a battery will last only so long so replacing it is not considered a “complication” when replacement is needed. You could also report Z45.49 (Encounter for adjustment and management of other implanted nervous system device) as a secondary diagnosis code but it would not be the primary diagnosis. The primary diagnosis is the patient’s condition that warranted the neurostimulator. This advice actually applies to spinal cord stimulator and vagus nerve stimulator battery replacement.

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

Shunt Revision

Question:

I had to replace the ventricular catheter and the valve on a patient with a VP shunt.  What code should I use?

Answer:

Actually you get two codes!  CPT 62225 is used for the ventricular catheter replacement and 62230 for the valve replacement.  Both codes are appropriate in this scenario.

*This response is based on the best information available as of 11/14/19.

Augmentation of Pedicle Screws

Question:

I injected cement into the pedicles to augment screws in a patient with osteoporosis. My coder suggested using +22859 (Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)) for this procedure but that didn’t seem right to me. What is your advice?

Answer:

We agree with you that +22859 is not accurate. Augmentation of pedicle screws is not separately reported as it is included in the posterior instrumentation code (e.g., +22840, +22842) when performed.

*This response is based on the best information available as of 10/31/19.

T9-11 Epidural Tumor Removal

Question:

I did bilateral laminectomies at T9, T10, T11 and removed an epidural tumor. I billed 63276-50, 63276-50-59 and 63276-50-59 but got paid for only 63276-50. Should I have used modifier XS (separate site) instead of 59?

Answer:

CPT 63276 (Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, thoracic) involves removal of the tumor and included any, and all, levels of laminectomy required for access and tumor removal. Also, the code also implies both sides of the lamina were removed. Therefore, in your situation, only 63276 alone should have been reported.

*This response is based on the best information available as of 10/17/19.