Billing Additional Pre-op Visit

Question:

Since we have to bring the patients back in for COVID testing and H&P for Joint Commission, can we bill for this visit even though it’s another pre-op visit?

Answer:
Yes, since the original surgery was canceled and is now under consideration for rescheduling due to the pandemic and needs to be seen for a COVID swab prior to surgery, which is an indication for charging a new visit (as a health status change)

*This response is based on the best information available as of 06/02/22.

Inpatient E/M Coding

Question:

I did an inpatient consultation and coded 99253 (non-Medicare). I did not need to follow the patient so I signed off. They asked me to re-consult a week later.  What is the code for a re-consult?

Answer:
There are no specific E/M codes for an inpatient re-consultation.  You’ll use the subsequent hospital care code, 9923x, since it’s the same admission for the patient.

Question:Follow up question: the patient was discharged then admitted a month later and I was consulted again. Is this a subsequent hospital care code?

Answer:
No, since it’s a new admission for the patient, you’ll use the consultation code again (9925x).

Question:Last question: when I see the patient in my office a month later, is it a new patient?

Answer:
No, it’s an established patient (9921x) because you’ve had a face-to-face visit with the patient in the previous 3 years.

*This response is based on the best information available as of 05/19/22.

ER Visit Coding

Question:

What code do we charge for an ER visit when our physician was called to the ER by the ER doctor. The patient has Medicare.

Answer:

If the patient was not admitted by you to the hospital (e.g., they were admitted by another service or discharged), then you code it as an ED visit, 9928x, when the payor does not recognize the consultation (9924x) codes.

*This response is based on the best information available as of 05/05/22.

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.