Coding for Percutaneous Screws and Rod Placement

Question:

I placed posterior percutaneous screws and rods without an arthrodesis. I know I have to use an unlisted code, 22899. How should I price it?

Answer:

Good question. Let’s assume you’re doing +22842 (posterior instrumentation, 3-6 segments) which is an add-on code. Add-on codes are valued for only the intra-operative portion of the service and do not include any value for pre-op (e.g., H&P, discussion with patient), certain intra-operative work (e.g., incision, closure) or post-op work.

Recall that Medicare reduces the payment for secondary stand-alone procedure codes by 50% to account for overlapping pre- and post-op work.

Therefore, we recommend you double your fee for +22842 to achieve your fee for the unlisted code. For example, if your fee for +22842 is $100 then your fee for the unlisted code would be $200.

*This response is based on the best information available as of 07/14/22.

Modifiers on Unlisted Codes. Yes or no?

Question:

Can I use modifiers on an unlisted code?

Answer:

There is not a single right answer to this question. CPT said, in an old CPT Assistant, that generally modifiers are not appended to an unlisted code.

Payors have their own rules. For example, some payors will accept modifier 62 (two surgeons/co-surgery) on an unlisted code such as 64999 while other payors do not.

We would not append modifier 50 (bilateral procedure) to an unlisted code. Your base, or comparison code, should reflect modifier 50 and the associated increase in fee. The same is true for modifier 22.

We also would not append modifier 51 (multiple procedures) to an unlisted code. Let the payor take the discount.

What about global period modifiers such as 58, 78 or 79? It seems reasonable to append those modifiers to the unlisted code.

*This response is based on the best information available as of 06/30/22.

Re-exploration Laminectomy Billing

Question:

The patient had a re-do laminectomy for stenosis at L3-L4. Can code 63042 be used for this procedure?

Answer:
No. CPT 63042 is intended for a re-do discectomy and would be inappropriate to use for a re-do laminectomy. Rather, use 63047 for this service and modifier 22 may be appended if significant additional work is documented.

*This response is based on the best information available as of 06/16/22.

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.