Renal Angiogram Coding

Question:

Is catheterization separately reported with renal angiograms?

Answer:

No. The renal angiogram codes, see table below, include all catheterization. The codes are selected by order of catheterization and as unilateral or bilateral. Also, remember that a flush aortogram is included in the renal angiogram codes and not separately reported.

CPT Code	Description
36251	Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral
36252	bilateral
36253	Supraselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral Do not report 36253 in conjunction with 36251 when performed for the same kidney.
36254	bilateral

New Patient Visit Denied, What Should I Do?

Question:

One of our pain management physicians saw a patient the first time in our office. We billed 99204. The insurance carried denied the service. I contacted the insurance carrier and was told that the patient was an established patient to the practice and should be reported as an established patient. The patient did see another pain management physician in our group practice who did an injection a year ago, but it was in another city. Is the insurance carrier correct or should I appeal this?

Answer:

Since the pain management physician in the other city is part of your group and is of the same specialty with the same taxonomy code, the patient encounter for the physician in your office should be coded as an established patient visit not a new patient visit.

Per CPT Coding Guidelines: “A new patient is one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care professional of theexactsame specialtyand subspecialtywho belongs to the same group practice, within the past three years.”

Since your claims was denied, it is recommended that you file a corrected claim and bill the encounter as an established patient.

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.

Billing for a Wound Vac

Question:

Can you bill for a wound vac on a surgical incision if the patient has a history of incision infections to help prevent this?

Answer:

The AMA published clarification on wound vac billing in the October 2021 CPT Assistant. Negative pressure wound therapy (97605-97606) is considered billable for both open and closed wounds. However, that does not mean that payors will reimburse separately for the service, so use caution and track results.

*This response is based on the best information available as of 03/10/22.

Office Visit & Procedure on Same Day – Using Modifier 25

Question:

We frequently do a flexible laryngoscopy (31575) or nasal endoscopy (31231) when we see a patient. We always bill the office visit code with modifier 25. Lately, we seem to be getting more denials and have to send in our note for justification. We don’t always get paid. Can you shed any light on this issue?

Answer:

Good question and our clients are telling us they are also seeing more denials for modifier 25. The answer is long and complicated which is why Kim is doing a webinar on proper use of modifier 25 on March 23, 2022. In general, frequently it is appropriate to report both an E/M code and the minor procedure on the same day for new patients. However, for established patients where you’re evaluating them for the same problem and you do the procedure it may only be appropriate to report the procedure code if you are not changing the plan of care or doing any additional medical decision making.

Be sure to sign up for Kim’s modifier 25 webinar here:https://karenzupko.com/using-modifier-25-in-otolaryngology-rewards-and-ramifications/. And, remember, the 2nd edition of Kim’s ENT coding book was recently published – you can order it here and get the KZA discount:https://karenzupko.com/the-essential-guide/.

*This response is based on the best information available as of 03/10/22.

Closing the Partial Mastectomy Wound

Question:

A patient has a partial mastectomy by a general surgeon. After the surgery, a plastic surgeon comes in to close due to possible reconstruction. The plastic surgeon ends up only doing a layered closure. A layered closure is inclusive the in the partial mastectomy (19301) but is the plastic surgeon still able to get credit for the layered closure (12034) because she is a different specialty?

Answer:

In our experience, no, the plastic surgeon would not be reimbursed for a simple, intermediate or complex repair code in this situation. Sorry. Good question though!