Providing the exposure for a neurosurgeon. How is it coded?

Question:

A neurosurgeon asked my vascular surgeon to perform the exposure for an anterior spine procedure.  Does he report an exploratory lap his work?

Answer:

No. providing the exposure for a neurosurgeon for an anterior spine  procedure is co-surgery, since code 22558,Arthrodesis, anterior interbody techniqueincludes both the exposure/approach and the work on the spine.  Both surgeons append the co-surgery modifier 62 to code 22558.

*This response is based on the best information available as of 10/17/19.

Reporting 75630 with Extremity Angiograms

Question:

Can code 75630, aortogram, be reported with a unilateral or bilateral extremity angiogram (75710 of 75716)?

Answer:

No. This would constitute double billing of the extremity angiograms.  As shown below, code 75630 includes an aortogram and visualization and interpretation of bilateral lower extremity arteries via a run-of.  For this code, a catheter is advanced to the infra-renal aorta and, without moving the catheter farther down the aorta or in one of both extremities, a run-off of contrast provides imaging of the both extremities to include the iliac and femoral arteries.

Code 75625 is for an aortogram, only. Code 75710 or 75716 is reported in addition to 75625 if the catheter is moved to the aorta bifurcation or into one of both extremities, providing additional imaging of one or both legs.

75630

Aortography, abdominal plus bilateral iliofemoral lower extremity

75625	Aortography, abdominal, non-selective
75710	Angiography, arm/leg(Unilateral)
75716	Angiography, arm/leg(bilateral)

*This response is based on the best information available as of 10/03/19.

Coding TCAR

Question:

What is TCAR and how is it coded?

Answer:

TCAR stands for Transcarotid Artery Revascularization.  It is essentially an open carotid stent procedure. A small incision is made just above the collar bone to expose the common carotid artery. A sheath is placed directly into the carotid artery and connected to flow reversal system, for embolic protection. A stent is placed via that incision to treat carotid occlusion.

This procedure is reported as 37215,Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection.

*This response is based on the best information available as of 06/20/19

Global Period for Debridement

Question:

I thought the global period of debridement of muscle or bone was 10 days. Is that true?

Answer:

The debridement codes were revised in 2011 and the global period for all codes (11042-11047) was revised to 0 days.

*This response is based on the best information available as of 3/14/19.

What does “separate procedure“ mean in a CPT code description?

Question:

What does “separate procedure” mean when it follows a CPT code description?

Answer:

Per CPT :Some of the procedures or services listed in the CPT codebook that are commonly carried out as an integral component of a total service or procedure have been identified by the inclusion of the term “separate procedure.” The codes designated as “separate procedure” should not be reported in addition to the code for the total procedure or service of which it is considered an integral component.

However, when a procedure or service that is designated as a “separate procedure” is carried out independently or considered to be unrelated or distinct from other procedures reported the code in addition to other procedures/services by appending modifier 59 to the specific “separate procedure” code to indicate that the procedure is not considered to be a component of another procedure, but is a distinct, independent procedure. This may represent a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries).

What does this mean in practice?If a code description includes the term “separate procedure”, if that procedure is in the same anatomic area as a more comprehensive procedure (for example, lyse of adhesions followed by a colectomy) only the more comprehensive procedure, the colectomy, is reported.

*This response is based on the best information available as of 2/14/19.

Fem- Fem Bypass

Question:

How is a left femoral to right femoral artery bypass with PTFE reported?

Answer:

Report code 35661, Bypass graft, with other than vein, femoral- femoral. This code applies to fem-fem bypass in the same leg or from one leg to the opposite leg.

*This response is based on the best information available as of 1/17/19.