Billing for Comparison Views

Question:

Can we bill comparison in-office x-ray views (usually knees or elbows) if the patient is asymptomatic on the contralateral (opposing) side?

Answer:

Unless there is a medically necessary reason for the comparison views on the contralateral body part, they should not be billed separately. If documentation does support billing for both sides, select the CPT by number of views and add the appropriate modifier (e.g., 3 views of the left knee and 2 views of the right knee 73562 LT and 73560 RT).

Portable Ultrasound Equipment

Question:

Our physician’s submitted literature to our administration team related to portable handheld ultrasound equipment for purchase consideration. I was asked if this equipment met CPT requirements for ultrasound. Is this equipment acceptable to use when performing ultrasound guided injections?

Answer:

We recommend you research the website literature for product specifications or contact the vendor. The key will be that the technology must be able to capture and save images in the medical record. The images will need to show the needle localized in the specific anatomic site.

CPT codes that state “with ultrasound guidance” (e.g. Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting) or codes such as CPT code 76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation) will not be reportable if the technology does not have the capacity to save the images to the medical record.

Modifier Order on CMS Claim Form

Question:

We are submitting a hospital claim form with the modifier 25 and FS modifier. We are unsure which modifier to list first. What is your recommendation?

Answer:

Thanks for contacting KZA and remembering to use the FS modifier for shared services provided in the hospital. KZA recommends placing the modifier 25 first, as this is considered a reimbursement modifier followed by the FS modifier, which is an informational modifier.

29855 or 0707T?

Question:

Our surgeon documented in the procedure title that he performed an arthroscopic ORIF of a tibial plateau subchondral fracture with injection of calcium phosphate, and he wants to report CPT code 29855(Arthroscopically aided treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed (includes arthroscopy). I do not see an actual ORIF but do see the injection of the calcium phosphate.

I believe I read somewhere that this is not correct, but I cannot find my source.

Answer:

You are correct to question this and yes, CPT has addressed this several times in their AMACPT Assistantpublication in recent years. In 2019, they advised that CPT code 29855 is not the correct code for the brief description you provide.

In January 2022, CPT published Category III code 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)as the code to use to report this work.

Consultations in 2023

Question:

I am putting together E&M Guideline educational information for my providers based on the 2023 changes for reference throughout the year. I did some education in 2022 and now working on the tools. In 2022, I kept hearing that inpatient and outpatient consultation codes were being deleted. However, they are still listed in the 2023 CPT Manual. Are you able to help me?

Answer:

You are correct; the inpatient and outpatient consultation services (i.e. 99242-99245 and 99252-99255) remain valid CPT codes in 2023. Perhaps the point of confusion is that CPT codes 99241 and 99251 were deleted to align the Medical Decision Making (MDM) levels with the levels that were defined in 2021 for the office outpatient codes and the 2023 hospital changes.

Remember, Medicare does not accept consultation codes and nothing changes for Medicare in 2023; the consultation codes in the Medicare fee schedule continue to have an Invalid code status. Some private payors have published guidelines stating they do not allow payment for consultations, but the codes remain current; there are payors who still recognize consultation codes.

Retinacular Repairs

Question:

Our surgeon documented a repair of the patella tendon with repair of the medial retinaculum repair. The surgeon wants to code for the retinacular repairs and I can’t find a CPT code. Are you able to assist?

Answer:

Thanks for your inquiry. A retinacular repair is inclusive to other surgical repairs (e.g. tendon or ligament) thus there is no additional code to report.