E/M Coding for Emergency Surgery

Question:

Under the revised 2023 EM guidelines what E/M code would be supported for seeing a patient in the the ED for a ruptured cerebral aneurysm and taking them emergently to surgery for repair?

Answer:

This scenario would support , 99223, the highest level of Initial hospital care. Based on:

• High Problem-Acute or chronic illness or injury that poses a threat to life or bodily function and,
• High Risk- Emergency surgery

Remember, only 2 of the 3 medical decision-making elements are needed to support a level of E/M.

*This response is based on the best information available as of 12/14/23.

Kyphoplasty Coding

Question:

How do you report a kyphoplasty at 2 different spine regions, for example at T12 and L1?

Answer:

Use one primary procedure code and an add-on code for additional levels even when crossing spinal regions. Example: T12 and L1 kyphoplasty is reported using 22513 and +22515,not22513 and 22514.

*This response is based on the best information available as of 11/30/23.

Coding Percutaneous Rods and Screws: Part 3

Question:

If percutaneous rods and screws are placed without a parent or primary code, for example as a staged procedure a different day after an ALIF or as the sole treatment for a vertebral fracture. I understand an unlisted code (22899,Unlisted procedure, spine) must be reported. What should be used as a comparative code to set the fee. The instrumentation codes, +22840, etc?

Answer:

Yes, use the appropriate posterior instrumentation code as the comparative code but double your fee/charge. As add-on codes, the posterior instrumentation codes are valued only for intraoperative work as they are expected to be reported with a parent /primary code. Double your fee/charge to account for this additional work not included in the instrumentation add-on code.

*This response is based on the best information available as of 11/2/23.

Coding Percutaneous Rods and Screws: Part 2

Question:

What if we the neurosurgeon places percutaneous screws and rods (no posterior fusion/bone graft) as the sole treatment for a vertebral fracture. Do we code the regular posterior instrumentation codes, for example +22840 or +22842?

Answer:

Unfortunately, no. Placement of percutaneous screws and rods as the sole procedure must be reported with an unlisted code (22899, Unlisted procedure, spine).

The posterior instrumentation codes (+22840-+22843) are add-on codes and can only be reported with an applicable primary or parent procedure code. Therefore, in this scenario, only the unlisted code may be reported.

*This response is based on the best information available as of 10/19/23.

Coding percutaneous rods and screws: Part 1

Question:

What if we do the surgeon does an ALIF, 22558 on one day then the second day the only procedure is placing a percutaneous screws and rods (no posterior fusion/bone graft).  Do we bill +22840-58 on the second day?

Answer:

Placement of percutaneous screws and rods is reported using the usual posterior instrumentation codes. However, when there is no applicable primary procedure code such as in this case then you’ll have to use an unlisted code for the procedure (22899 Unlisted procedure, spine).

*This response is based on the best information available as of 10/5/23.

Placement of Percutaneous Posterior Instrumentation (Rod and Screws) Part 2

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.

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 08/03/23.