Stent vs. Embolization or Both

Question:

If the surgeon uses a covered stent and performs an embolization on a patient with a pseudoaneurysm, can we bill for both the stent and removal of the embolus?  

Answer:

If a covered stent is deployed as the sole management of an aneurysm, pseudoaneurysm or vascular extravasation, then the stent deployment should be reported and not the embolization code.

*This response is based on the best information available as of 4/11/24.

Coding +34713

Question:

Can code 34713 for placement of a larger than 12 French sheath in endograft placement be reported with an open exposure of the same artery?

Answer:

No, add-on code +34713 is specifically for percutaneous placement. See code description below. 

+34713 - Percutaneous access and closure of femoral artery for delivery of endograft through a large sheath (12 French or larger), including ultrasound guidance, when performed unilateral (List separately in addition to code for primary procedure)  

*This response is based on the best information available as of 2/29/24.

Denials for Initial Hospital Care and Observation E/M Codes: 2024

Question:

We are experiencing denials when we bill 99221-99223 and the place of service is observation (outpatient hospital).  Are we doing something wrong?

Answer:

You are billing correctly based on CPT 2023 guidelines for E/M that merged inpatient hospital encounters/codes with observation encounters/codes.  Unfortunately, some payor claims processing systems may not yet recognize these changes as they apply to billing.  You will have to appeal these denied claims, with CPT references showing the current guidelines for E/M reporting. 

*This response is based on the best information available as of 2/15/24.

Modifiers with Unlisted Codes

Question:

Can I use modifiers on an unlisted code?

Answer:

In some circumstances, a modifier may be appropriately appended to an unlisted code.

For example,

• CPT says, while uncommon, if multiple separately reportable unlisted codes are performed on the same patient on the same date by the same physician, multiple unlisted codes may be reported. If the two procedures are performed in the same anatomic region, then multiple units of the unlisted code may be reported with a modifier 59

• Modifier 62 (two surgeons/co-surgery) may also be appended to an unlisted code such as 64999 if co-surgery is documented.

• Modifier 58 for staged or more extensive procedures may also be appended to alert the payor to a second surgery during the global period,

• During the global period, it may also be appropriate (and recommended) to append global period modifiers such as 78 or 79 to an unlisted code to fully describe the surgical scenario to a payor.

Do not append modifier 50 (bilateral procedure), modifier 51 or modifier 52 or 53 to an unlisted code. Your base, or comparison code, should reflect modifier 50 and the associated increase in fee. The same is true for modifier 22.

*This response is based on the best information available as of 2/1/24.

E/M Coding for Emergency Surgery

Question:

Under the revised 2023 EM guidelines what E/M code would be supported for seeing a patient in the the ED for a ruptured abdominal aorta aneurysm (AAA) and taking them emergently to surgery for repair?

Answer:

This scenario would support , 99223, the highest level of Initial hospital care. Based on:

• High Problem-Acute or chronic illness or injury that poses a threat to life or bodily function and,
• High Risk- Emergency surgery

Remember, only 2 of the 3 medical decision-making elements are needed to support a level of E/M.

Coding for TCAR

Question:

How is the TCAR procedure reported?

Answer:

Transcarotid Artery Revascularization (TCAR) is a minimally invasive procedure that can clear blockages and open a narrowed cervical carotid artery. The surgeon makes an incision over the common carotid artery to perform the repair. During the TCAR procedure, the surgical team reverses blood flow in the area of the blockage.

TCAR is reported with the same code as a carotid stent, 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.