Interposition Arthroplasty CMC Joint Denial

Question:

Our surgeon documented an interposition arthroplasty and removal of both the trapezoid and trapezium bones. I reported CPT code 25447 for the arthroplasty and 25210-59 for the removal of the trapezoid (in this case the second bone). I know CPT code 25447 includes the removal of one bone but not both. I coded this according to CPT rules as the patient is not Medicare.

Answer:

Thank you for your inquiry. Without seeing the operative note the coding is correct as shared.

KZA recommends you appeal using the AAOS Global Service Data Guide summary for CPT code 25447. It specifically states that the removal of either the trapezium or trapezoid is included in CPT code 25447. The key is the term “or”. Bone bones are not typically removed, and removal of the second bone requires additional work for the surgeon.

The use of modifier 59 is correct based on CPT rules of “different structure.”

Billing Additional Pre-op Visit

Question:

Our surgeon placed a patient on the OR schedule as an inpatient case. The surgery was elective and not an emergency case. The patient’s case was canceled because our hospital limited inpatient elective OR cases due to the spike in COVID 19 cases in our area.

The patient is now being rescheduled. The surgeon will bring the patient back to evaluate the patient, verify that the patient is still a surgical candidate and order all labs, including the hospital required COVID testing. Is this second encounter reportable even though it’s another pre-op visit?

Answer:

Yes, this would not be considered a ‘second’ pre-op visit as the prior planned surgery was canceled.

Coding a Discectomy with a Posterior Lumbar Interbody Fusion

Question:

Can we code a laminectomy for disc herniation, such as 63030 or 63042, with a TLIF/PLIF code (22630, 22633)?

Answer:

Good question! There was an update in CPT 2022 to this very complicated and lengthy issue. No – a discectomy may not be separately reported (e.g., 63030, 63042, 63056) since it is required for the posterior lumbar interbody fusion. However, there are new codes – +63052 and +63053 – that may be separately reported when a unilateral or bilateral laminectomy/facetectomy/foraminotomy for decompression is performed. Learn more from our recent 2022 CPT Update for Spine Surgery webinarhere.

OATS Procedure Humeral Head

Question:

Our surgeon will be performing an OATS procedure with allograft on the humeral head. Will you advise on what CPT code we should report?

Answer:

Thanks for your inquiry. There is no CPT code for this procedure. You will use an unlisted code based on the approach.

Report CPT code 24999,Unlisted procedure, humerus or elbowif the procedure is performed as an open procedure.

Report CPT code 29999,Unlisted procedure, arthroscopyif the procedure is performed arthroscopically.

CPT has category I codes for OAT with allograft in the knee (27415, 29867), and these could be considered for comparison.

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.