Modifiers with Unlisted Codes

Question:

Can I use modifiers on an unlisted code? 

Answer:

In some circumstances, a modifier may be appropriately appended to an unlisted code. 

For example,  

• CPT says, while uncommon, if multiple separately reportable unlisted codes are performed on the same patient on the same date by the same physician, multiple unlisted codes may be reported. If the two procedures are performed in the same anatomic region, then multiple units of the unlisted code may be reported with a modifier 59 

• Modifier 62 (two surgeons/co-surgery) may also be appended to an unlisted code such as 64999 if co-surgery is documented.  

• Modifier 58 for staged or more extensive procedures may also be appended to alert the payor to a second surgery during the global period, 

• During the global period, it may also be appropriate (and recommended) to append global period modifiers such as 78 or 79 to an unlisted code to fully describe the surgical scenario to a payor. 

Do not append modifier 50 (bilateral procedure), modifier 51 or modifier 52 or 53 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.

*This response is based on the best information available as of 2/29/24.

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.