Postoperative Spinal Wound Infection

Question:

Our surgeon performed a thoracolumbar spinal procedure two weeks ago. The patient developed a wound infection requiring surgical intervention. The surgeon’s note indicates that subfascial irrigation and debridement was performed from T10 through L5. In reviewing the CPT manual, I see codes for the cervical/thoracic and the lumbar/sacral regions. Should both codes 22010 and 22015 be reported for this return to the operating room during the global period since the surgeon did work in both the thoracic and lumbar regions?

Answer:

CPT codes 22010 and 22015 may not be reported together during the same operative session. Incision and drainage at the thoracolumbar junction would be reported with the code describing the region where the majority of the work is performed.

In this scenario, the majority of work was performed in the lumbar spine. Thus, CPT code 22015 (Incision and drainage, open, of deep abscess [subfascial], posterior spine; lumbar, sacral, or lumbosacral) should be reported.

Append Modifier 78, indicating a return to the operating room for a related procedure to indicate this was an unplanned return during the global period of the original procedure.

Injections with Ultrasound Guidance

Question:

Is it correct CPT coding to report the ultrasound guidance CPT code 76942 when the physician performs tendon injections or a carpal tunnel injection? The CPT code descriptions for 20550, 20551, and 20526 do not include the terms “with ultrasound guidance, with permanent recording and reporting” in their definitions.

Answer:

There is no AMA CPT coding restriction to reporting CPT code 76942 (Ultrasonic guidance for needle placement [eg, biopsy, aspiration, injection, localization device], imaging supervision and interpretation) when ultrasound guidance is medically necessary for needle localization. These codes do not include image guidance as part of the CPT description like the joint injection CPT codes do (20604, 20606, 20611).

Medical necessity must be present and documented to support this additional work and service.

Refer to payor policies for medical necessity requirements for reporting CPT code 76942 in addition to injections that do not include this work as part of their description.

*This response is based on the best information available as of 12/30/21.

Achilles Tendon Debridement/Debulking

Question:

Our surgeon took a patient to the OR for secondary repair of an Achilles tendon tear. He found that the tear was essentially gone and the tissue was very scarred. He performed a debridement and debulking of the scarred tissue. Is this reported with CPT code 11044 or 27654?

Answer:

Thanks for your inquiry. Based on the information you provided, and according to a CPT Assistant article published in April 2020, the correct code is 27654 Repair, secondary, Achilles tendon, with or without graft

CPT code 11044 describes debridement to and including bone. CPT code 11044 would be incorrect for two reasons: 1) bone was not debrided and 2) the CPT Assistant directs the surgeon to use 27654.

*This response is based on the best information available as of 12/16/21.

Subchondroplasty

Question:

Our surgeons occasionally perform subchondroplasty procedures. We are reporting this with an unlisted code and are wondering if this is correct.

Answer:

Yes, through the remainder of 2021 you will continue to report an unlisted CPT code. The AMA released a new Category III code in July 2021, but it is not effective until January 1, 2022.

0707T:     Injection(s), bone-substitute material (eg, calcium phosphate) into subchondral bone defect (ie, bone marrow lesion, bone bruise, stress injury, microtrabecular fracture), including imaging guidance and arthroscopic assistance for joint visualization

The following guidelines apply to this new Category III code.

• Do not report 0707T in conjunction with 29805, 29860, 29870, 77002
• For aspiration and injection of bone cysts, use 20615

Source:https://www.ama-assn.org/system/files/cpt-category3-codes-long-descriptors.pdf10/26/2021

*This response is based on the best information available as of 12/02/21.

Balloon Spacer in the Shoulder

Question:

Our orthopaedic shoulder surgeon treated a patient with two massive rotator cuff tears that were not amenable to repair. Due to patient age, the patient would not withstand a reconstructive procedure. Our surgeon placed a balloon spacer arthroscopically in the subacromial space. We are wondering how to code for this procedure.

Answer:

Thank you for your inquiry. There is no CPT code for this very interesting procedure for a patient who is not a surgical candidate. You will report an unlisted arthroscopic code, 29999. Work with your surgeon to find a code that most closely represents the work. Do not code 29826 separately if the acromion is shaved or reshaped to allow placement and insufflation of the implant.

*This response is based on the best information available as of 10/14/21.

Reconstruction of the ATFL and CFL

Question:

Our foot and ankle surgeon performed a reconstruction of the ATFL and the CFL ligament in the left leg for a chronic injury. We are looking at CPT codes and wondering if we should be reporting CPT code 27696 or CPT code 27698. Which code would you recommend?

Answer:

Thank you for your inquiry. Without seeing the operative note, and addressing only your Question:, the correct code is CPT code 27698.

Let’s take a look at the two codes in Question:

• 27696 Repair, primary, disrupted ligament, ankle; both collateral ligaments.• 27698 Repair, secondary, disrupted ligament, ankle, collateral (eg, Watson-Jones procedure)

The ATFL (anterior talofibular ligament) and the CFL ( calcaneofibular ligament) are ligaments of the lateral complex in the ankle.

CPT code 27698 describes the secondary repair (or reconstruction) of the “collateral” ligament of the ankle, while CPT code 27696 describes a primary repair of both the medial and lateral ligaments in the ankle.

CPT Assistant has advised that a secondary repair code can be used is multiple circumstances, including for chronic injuries and when another tissue is used to perform the repair (reconstruction). A reconstruction would not be performed if the ligament was repairable.

*This response is based on the best information available as of 09/30/21.