Anterior and Posterior Labral Repairs

Question:

Our surgeon documented anterior inferior labral repairs and then documented posterior inferior repairs.  The surgeon wants to report 29806 x 2 and I do not believe that is correct.  Will you assist?

Answer:

Thank you for your question. You are correct in that CPT code 29806 may not be reported twice. You will report 29806-22 once that includes both labral repairs. Remember to increase your standard fee to signify this code is different than the traditional code (no modifier).

Costochondral Injection

Question:

We saw a patient who presented with chest pain and the physician diagnosed costal chondritis and the administered an injection into the costochondral junction. We are debating what CPT code to report for the injection? Is it 20550, 20600, 20605 or an unlisted code? We are considering CPT code 20600.

Answer:

Thank you for your inquiry. This is not your typical orthopaedic injection! From a CPT coding perspective, the correct code is CPT code 20605 when Ultrasound Guidance is not a component of the service. The diagnosis is M94.0 (Chondrocostal junction syndrome).

Note: This advice is based on guidance from the AMA’s CPT Knowledge Base, revised in 2015 (KB #5189). The specific Q&A is available through AMA subscription.

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.