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Foreign Body Removal
A patient had a craniotomy a week ago and the provider is doing a removal of a retain drain of post op wound in the operating room. What is the best code to use 10120?
Question:
A patient had a craniotomy a week ago and the provider is doing a removal of a retain drain of post op wound in the operating room. What is the best code to use 10120?
Answer:
The best code is 10121, incision and drainage of foreign body, complex, since this required a return to the OR and was done for retained cranial drain. Remember to add a 78 modifier, for a return to the OR.
*This response is based on the best information available as of 12/01/22.
Counting Laminectomy Levels
I am confused and hoping you can clarify a coding question I have. I thought I understood how to report laminectomy levels, however, after recently reading an article in the AHA Coding Clinic HCPCS Volume 22, Number 2 Second Quarter 2022 publication, I doubt myself. The surgeon performs and documents a L2, L3, L4 laminectomy with decompression (lateral recess). I have always coded this as 63047, and one unit of 63048. The coding publication I was reading states to report 63047 and 2 units of 63048. Have I been coding incorrectly by only reporting one unit of 63048?
Question:
I am confused and hoping you can clarify a coding question I have. I thought I understood how to report laminectomy levels, however, after recently reading an article in the AHA Coding Clinic HCPCS Volume 22, Number 2 Second Quarter 2022 publication, I doubt myself. The surgeon performs and documents a L2, L3, L4 laminectomy with decompression (lateral recess). I have always coded this as 63047, and one unit of 63048. The coding publication I was reading states to report 63047 and 2 units of 63048. Have I been coding incorrectly by only reporting one unit of 63048?
Answer:
Thank you for contacting KZA for clarification. We understand your concern when reading various publications and seeing articles that are not consistent with what you thought you knew.
Without seeing an actual operative note, we agree with how you have coded this type of case in the past. Let’s take a look why.
CPT code 63047 is defined as “Laminectomy, facetectomy and foraminotomy (unilateral or bilateral) with decompression of spinal cord, cauda equina and/or nerve root(s), (e.g., spinal or lateral recess stenosis)),single vertebral segment; lumbar”
A “vertebral segment” means per motion segment. The decompression of the existing nerve root is performed in the interspace between the two lamina.
L2, L3, L4 when looked at closely defines two motion segments:
L2-3 =63047
L3-4= 63048 x 1 unit.
To report a third unit of 63048, the surgeon would either have had to go “up a level” to L1-L2, or “down a level” to L4-5.
We appreciate your verifying your coding practices.
*This response is based on the best information available as of 11/17/22.
Coding for Trigeminal Neuralgia #3
How is RFA rhizotomy of the trigeminal nerve at the second and third division branches of the foramen ovale reported ? The diagnosis was Trigeminal Neuralgia.
Question:
How is RFA rhizotomy of the trigeminal nerve at the second and third division branches of the foramen ovale reported ? The diagnosis was Trigeminal Neuralgia.
Answer:
This procedure is coded as 64605, Destruction by neurolytic agent, trigeminal nerve second and third division branches at foramen ovale .Code +77002 may also be reported if fluoroscopy is used, documented, and a permanent image is retained.
*This response is based on the best information available as of 11/03/22.
Coding for Trigeminal Neuralgia #2
How is percutaneous ganglion balloon compression rhizotomy of the trigeminal nerve reported? The diagnosis was Trigeminal Neuralgia.
Question:
How is percutaneous ganglion balloon compression rhizotomy of the trigeminal nerve reported? The diagnosis was Trigeminal Neuralgia.
Answer:
This procedure is reported with an unlisted code, 64999. There is no CPT code for this percutaneous procedure.
*This response is based on the best information available as of 10/20/22.
Coding for Trigeminal Neuralgia #1
A retrosigmoid craniotomy was performed with microvascular decompression of the 5th nerve. The diagnosis was Trigeminal Neuralgia. How is this coded?
Question:
A retrosigmoid craniotomy was performed with microvascular decompression of the 5th nerve. The diagnosis was Trigeminal Neuralgia. How is this coded?
Answer:
This procedure is reported with code 61458,Craniotomy, suboccipital, for exploration or decompression of cranial nerves.
*This response is based on the best information available as of 10/06/22.
Coding a Decompressive Craniectomy
In a recent head trauma case, a decompressive craniectomy was performed with a partial temporal lobectomy, due to extensive damage. A hematoma was also evacuated. can we bill for the 61323 decompressive craniectomy code with lobectomy since only a partial lobectomy was done? And what about cooing for the hematoma evacuation?
Question:
In a recent head trauma case, a decompressive craniectomy was performed with a partial temporal lobectomy, due to extensive damage. A hematoma was also evacuated. can we bill for the 61323 decompressive craniectomy code with lobectomy since only a partial lobectomy was done? And what about cooing for the hematoma evacuation?
Answer:
For the procedure described, code 61323, decompressive craniectomy with lobectomy, may be reported, even with a partial lobectomy. The hematoma evacuation is included in code 61323.
*This response is based on the best information available as of 09/22/22.