Spine Fracture Repair and Decompression

Question:

How do I code for repair of a C6-7 fracture/dislocation where I did a laminectomy for decompression to repair the fracture as well as an arthrodesis?

Answer:

You’ll use CPT 22326 (Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; cervical) for the open cervical fracture/dislocation repair. Additionally, you may report codes for the arthrodesis (e.g., 22600), instrumentation (e.g., +22840) and bone graft (e.g., +20936). Do not separately report a decompression code (e.g., 63001) for the laminectomy at the same level of the fracture repair procedure (22326).

*This response is based on the best information available as of 8/6/20.

Removal of sEEG Electrodes

Question:

I placed subdural stereo-EEG electrodes for epilepsy monitoring. What is the code for removal of these electrodes? I’ve been billing 61880 for removal of each electrode up to 10 or 13 units depending on how many electrodes I remove. My new coder said she’s not sure we are using the correct code. Please help.

Answer:

We agree with your coder and there are actually two coding issues here. First, the CPT descriptor for 61880 says “Revision or removal of intracranial neurostimulator electrodes”. Notice the code is specifically for removal of neurostimulator electrodes, not epilepsy monitoring electrodes.

Second, note the word “electrodes” is plural, meaning more than one electrode. So not only are you using an incorrect code but you are also reporting an incorrect number of units.

There really isn’t a good code for removing subdural stereo-EEG electrodes unless you’re lifting a bone flap (61535). In the absence of a craniotomy for removal of the electrodes, you could sum the length of the wound repairs and report a wound repair code (e.g., simple repair 12001) or use an unlisted code (64999).

*This response is based on the best information available as of 7/9/20.

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.