Use of an Endoscope

Question:

If an endoscope is used to check for residual tumor or ensure an aneurysm is clipped, is there a code for that or should we also bill an unlisted code?

Answer:

There is no separate coding for this – ensuring that the procedure you’re billing for is adequately performed would not be separately reported.

*This response is based on the best information available as of 01/27/22.

Intraoperative Ultrasound

Question:

I see there is a code for intraoperative ultrasound, 76998. Can I code that when I use ultrasound intraoperatively to assist with tumor removal?

Answer:

No – intraoperative ultrasound is included in the tumor removal surgical CPT code and should not be separately reported by the surgeon.

*This response is based on the best information available as of 12/02/21.

ICP Monitor and EVD Placed on Both Sides

Question:

We placed an ICP monitor on the left side of the cranium and a right ventriculostomy, both using the twist drill. We know to use CPT 61107 but wondered about using modifier 50 (bilateral procedure). Thoughts?

Answer:

Medicare does not recognize modifier 50 on 61107, though some payors might or may even recognize using HCPCS II modifiers RT (right) and LT (left). We suggest you report 61107 and 61107-59 (or modifier XS) just to be clear that the same CPT code was performed on either side of the head.

*This response is based on the best information available as of 10/29/20.

Elective Cranioplasty after Emergent Hemicraniectomy

Question:

I did an emergency craniectomy on a stroke patient 4 months ago. It is now time to reconstruct the defect and I’ll be doing that by placing some mesh and screws with Methyl methacrylate. Should I be using the 62140/62141 code series?

Answer:

Actually, CPT considers what you are doing to be “Replacement of bone flap or prosthetic plate of skull” which is 62143. You would still use 62143 even if you reconstructed the defect with the patient’s own bone flap that was stored at the bone bank or with an alloplastic implant designed for the patient.

*This response is based on the best information available as of 10/15/20.

Post-Op Anterior Cervical Wound Abscess

Question:

How do I code for repair of wound dehiscence with deep abscess status post ACDF (anterior cervical discectomy, decompression and fusion)? I looked at 22010 but that’s for a posterior procedure.

Answer:

Take a look at 21501 (Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax) to see if it meets your needs.

*This response is based on the best information available as of 10/1/20.

VP Shunt Re-programming During a Global Period

Question:

What if we have to re-program a VP shunt during the global period because the settings need to be adjusted – can we bill for it or is it considered part of the 90-day post-operative global period?

Answer:

Good Question:. The initial shunt programming, at the time of insertion, is included in the shunt placement code (e.g., 62223). However, subsequent shunt re-programming is not included. Therefore, you may separately report 62252 (Reprogramming of programmable cerebrospinal shunt) for the shunt re-programming even if you are in a global period. You may need to append modifier 58 to 62252 as it would be anticipated re-programming is needed if the patient’s condition changed.

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