Infected Knee

Question:

Will you please direct this question to Mary LeGrand? I was consulted to evaluate a patient to rule out a septic knee. I saw the patient in the morning and aspirated the joint; the fluid was cloudy and sent to pathology. Later that day I was notified of an increased cell count and decided to take the patient to the OR later that day for an arthrotomy with lavage. My coder is telling me that I cannot bill CPT code 20610 with the arthrotomy because of a Medicare payment edit. This makes no sense to me. Can you advise if I am able to report this aspiration or not?

Answer:

Thanks for your inquiry. Yes, the aspiration is reportable with CPT code 20610 as you note. You may also report the arthrotomy with knee lavage; for example, CPT code 27310. Your coder is correct in that an NCCI edit is present between the two codes when performed on the same knee, same session. However, in your scenario, they are performed same day, different sessions. Append a modifier 59 (distinct procedure) to CPT code 20610 to indicate the aspiration occurred at a different session on the same day. If your Medicare carrier has instructed to use the new “X” modifiers instead of modifier 59 to indicate the “separate encounter,” you would report 20610 XE instead of 20610-59.

Your service will be reported one of two ways:2731020610-59Or2731020610 XE

*This response is based on the best information available as of 10/08/15.

Medicare: Debridement Services in the Shoulder

Question:

We attend courses and receive education from KZA consistently on orthopaedic coding. Our practice recently hired a new billing manager and she states that the information we have been given is incorrect for Medicare related to arthroscopic debridement services. The billing managers external resource told her that 29822 or 29823 can be reported with other arthroscopic shoulder services as long there is no NCCI edit in place. We are telling the new manager that this is incorrect for Medicare.

Can you please help validate what we perceived we heard from KZA is correct? To re-state, our question evolves around reporting debridement services (CPT codes 29822 and 29823) to Medicare when the patient has other arthroscopic shoulder procedures on the same shoulder. We understood, and have told the new billing manager, that the debridement services are considered inclusive to other arthroscopic procedures performed and reported on the same day if the debridement services are performed on the same shoulder. Our manager is telling us that if there is no edit in place, for example with CPT code 29826 and 29822, that we can report both to Medicare. Again, for clarification, she cites a non-KZA resource person.

Answer:

Thanks for your loyalty and reaching out. Based on the information provided, you accurately perceived the instructions for reporting arthroscopic shoulder procedures to Medicare. While there are no NCCI edits between some of the arthroscopic procedures and either CPT code 29822 or 29823, it is considered incorrect coding to report one of these debridement codes in addition to other arthroscopic shoulder procedures performed on the ipsilateral or same shoulder. One common error in coding according to Column 1 and Column 2 code edits is assuming if there is no edit, that the code combination may be reported together.

The following source information used by KZA in all orthopaedic instructions is found in the January 2015 NCCI Musculoskeletal Chapter 4:“4. With the exception of the knee joint, arthroscopic debridement should not be reported separately with a surgical arthroscopy procedure when performed on the same joint at the same patient encounter. For knee joint arthroscopic debridement see the following paragraph.”

While a Column 1 or Column 2 edit may not exist in the Excel database, these written guidelines provide additional coding information in addition to the Column 1 and Column 2 edit. CPT codes 29822 or 29823 are not reportable with other arthroscopic shoulder procedures on the same shoulder, same session.*This response is based on the best information available as of 09/24/15.

Different Specialties, Same Tax ID

Question:

Can you help clarify the new patient rules related to multiple specialties in the same group practice? If we have different specialties (e.g., Pain Management, Podiatry, Rheumatology, Orthopaedics) can we charge a New Visit code when the patient is seen for the first time by a physician in a different specialty in the practice?

Answer:

Yes, the CPT rules and Medicare rules both allow the new patient visit rules in your scenario, which is very common in large multi-specialty groups or academic centers where all specialties bill under the same tax ID. The following is a direct citation from the 2015 AMA CPT Manual: “Solely for the purposes of distinguishing between new and established patients, professional services are those face-to-face services rendered by physicians and other qualified health care professionals who may report evaluation and management services reported by a specific CPT code(s). A new patient is one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.”

Thanks for reaching out to KZA for your coding needs!

*This response is based on the best information available as of 08/13/15.

CPT or HCPCS Tool?

Question:

We have recruited a new hand surgeon and she frequently applies aluminum finger splints which are molded by the surgeon or her medical assistant. Can we report CPT code 29130 for the application and molding of this splint?

Answer:

Thanks for this great Question:! The application of the splint code 29130 is not reportable for an off the shelf product such as the aluminum splint. Report the appropriate HCPCS code for the supply only.

*This response is based on the best information available as of 07/02/15.

Claw Toe

Question:

We are having some debate about whether CPT code 28285 (hammertoe repair) would be appropriate for fusion of a claw toe? The claw toe is the DIP joint; the hammertoe is the PIP joint. However, code 28285 does not specify which interphalangeal joint is corrected. Should we report 28285 or an unlisted code?

Answer:

A: Thanks for your inquiry. As you note, CPT does not specifically state which joint; it says “e.g., interphalangeal fusion.” The “e.g.” directs us that this is only an example. Therefore, CPT code 28285 is the correct code, assuming the documentation supports the work described by 28285. You will note in Code-X that the claw foot and claw toe diagnosis codes support the medical necessity to report CPT code 28285.

*This response is based on the best information available as of 04/09/15.

Bone Marrow Aspirate for Grafting

Question:

Our surgeon performed a bone marrow aspirate from the iliac crest when performing a spinal fusion. The surgeon gave me CPT code 38230, but I am wondering if this is correct. Can you illuminate this for me?

Answer:

While the aspiration of bone marrow is separately reportable, CPT code 38230 is not the correct code. This code describes the aspiration of bone marrow for transplantation, such as in a bone marrow transplant in an immunosuppressed patient. The correct code, when the aspirate is harvested from a separate surgical site via a separate incision for the intent of a fusion is CPT code 38220, Bone marrow; aspiration only. Append modifier 59 to indicate current procedure service.

*This response is based on the best information available as of 03/12/15.