Cerebellopontine Angle Surgery

Question:

I did a posterior fossa craniectomy for resection of a cerebellopontine angle tumor requiring the dura to be repaired with a synthetic graft and reconstruction of the cranial defect with a titanium mesh cranioplasty. I know I will use 61520 for the tumor removal. Can I use 62140 for the cranioplasty? What about 15769 for the synthetic graft? Lastly, I was told I could also use 15733 for the flap closure.

Answer:

OK, we agree with 61520 for the primary procedure. Reconstruction of the defect with titanium mesh is considered the “usual” closure so you would not also code 62140 (or 62141). CPT 15769 is for excision of an autologous graft, such as abdominal fat, so you could not use this code for a synthetic graft. In fact, there is no separate coding for repairing the dura with a synthetic graft – it is part of the primary procedure code, 61520. Lastly, 15733 for the muscle flap would also not be used for a “flap closure” as this also was part of the usual closure.

*This response is based on the best information available as of 04/21/22.

PA Billing ED Consult

Question:

Can a PA bill a consult if going to the ED at the request of the ED dr for a stroke? Assume this is a non-Medicare patient and the consult code gets paid.

Answer:

Yes, assuming that doing a consult in the ED is within the PA’s scope of practice in your state and the hospital allows the PA to provide this service. That said, some insurance companies have unusual rules that may not allow payment for a PA on a consult code so you’ll want to check on this.

*This response is based on the best information available as of 04/07/22.

High Intensity Focused Ultrasound (MRgFUS)

Question:

We are going to start doing this new procedure called High Intensity Focused Ultrasound to treat essential tremor and other tremors. I can’t find a CPT code for this procedure. Do we need to use an unlisted code?

Answer:

Actually there is a Category III CPT code for this procedure so you do not need to use an unlisted code. You’ll use 0398T,Magnetic resonance image guided high intensity focused ultrasound (MRgFUS), stereotactic ablation lesion, intracranial for movement disorder including stereotactic navigation and frame placement when performed.Be sure to check the payors coverage policy to see if this procedure is paid or if it is considered “experimental” or “investigational.”

*This response is based on the best information available as of 03/24/22.

PA Assisting on Angiogram / Coiling

Question:

Can we bill for a PA to assist on a cerebral angiogram? What about aneurysm coiling?

Answer:

Well you can try but there are two things to consider:

1. The operative note should have really good documentation showing why a PA was necessary and what exactly the PA did to assist.

2. Medicare does not allow payment for an assistant on the cerebral angiogram or aneurysm coiling codes. So while you might bill for the service, it may not be paid.

*This response is based on the best information available as of 03/10/22.

Coding a Discectomy with a Posterior Lumbar Interbody Fusion

Question:

Can we code a laminectomy for disc herniation, such as 63030 or 63042, with a TLIF/PLIF code (22630, 22633)?

Answer:

Good question! There was an update in CPT 2022 to this very complicated and lengthy issue. No – a discectomy may not be separately reported (e.g., 63030, 63042, 63056) since it is required for the posterior lumbar interbody fusion. However, there are new codes – +63052 and +63053 – that may be separately reported when a unilateral or bilateral laminectomy/facetectomy/foraminotomy for decompression is performed. Learn more from our recent 2022 CPT Update for Spine Surgery webinar here:https://karenzupko.com/2022-cpt-update-for-spine-surgery/

*This response is based on the best information available as of 02/24/22.

Coding for Vascularized Pericranial Graft

Question:

Can we code for harvest of vascularized pericranial graft during a left temporal craniotomy for resection of epidural abscess? If so what code should I use?

Answer:

No, that is not billable since it the graft was obtained through the same surgical exposure as the primary procedure.

*This response is based on the best information available as of 02/10/22.