Billing Ultrasound Guidance with Cranial Tumors

Question:

My surgeon uses ultrasound to facilitate locating lesions in the brain and wants to bill 76998-26 for imaging. Is this appropriate? 

Answer:

No, ultrasound to locate a lesion and/or to confirm adequate resection is included in n the primary procedure and not separately billed 

*This response is based on the best information available as of 2/15/24.

Intracranial Cerebral Venogram

Question:

How is an Intracranial cerebral venogram coded?

Answer:

Venous catheterization, with the catheter advanced into the intracanal venous circulation, is reported with code 36012, second order venous catheterization.  The venous imaging is typically a superior sagittal sinus venogram, 75780.

*This response is based on the best information available as of 2/1/24.

Intracranial Endovascular Venous Thrombectomy

Question:

How is an Intracranial endovascular venous thrombectomy coded?

Answer:

There are no intracranial venous endovascular codes, so this must be reported as an unlisted code, 64999.  If performed and documented, a venogram, and the venous catheterization may also be reported.

*This response is based on the best information available as of 12/28/23.

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.