Inpatient E/M Coding

Question:

I did an inpatient consultation and coded 99253 (non-Medicare). I did not need to follow the patient so I signed off. They asked me to re-consult a week later.  What is the code for a re-consult?

Answer:

There are no specific E/M codes for an inpatient re-consultation.  You’ll use the subsequent hospital care code, 9923x, since it’s the same admission for the patient.

Question:Follow up question: the patient was discharged then admitted a month later and I was consulted again. Is this a subsequent hospital care code?

Answer:

No, since it’s a new admission for the patient, you’ll use the consultation code again (9925x).

Question:Last question: when I see the patient in my office a month later, is it a new patient?

Answer:

No, it’s an established patient (9921x) because you’ve had a face-to-face visit with the patient in the previous 3 years.

*This response is based on the best information available as of 04/21/22.

Intraoperative ICG Dye Angiography

Question:

Can we bill the 92242 for the indocyanine green injection intraoperatively, for example to assess perfusion after a procedure? Can we bill for the injection using 15860?

Answer:

No, this service is included in primary surgery and not separately reported.

Coding a Hand Assisted Laparoscopy

Question:

The surgeon described the procedure as a ‘hand assisted laparoscopy”. He brought part of the bowel outside of the body for evaluation. Does this convert the procedure to open?

Answer:

Mobilizing the bowel outside the body (extracorporeally) during a laparoscopic procedure does not convert the procedure to open, it is still considered a laparoscopic procedure and coded as laparoscopic.

*This response is based on the best information available as of 04/21/22.

Cerebellopontine Angle Surgery

Question:

I did a posterior fossa craniectomy for resection of a cerebellopontine angle tumor requiring the dura to be repaired with a synthetic graft and reconstruction of the cranial defect with a titanium mesh cranioplasty. I know I will use 61520 for the tumor removal. Can I use 62140 for the cranioplasty? What about 15769 for the synthetic graft? Lastly, I was told I could also use 15733 for the flap closure.

Answer:

OK, we agree with 61520 for the primary procedure. Reconstruction of the defect with titanium mesh is considered the “usual” closure so you would not also code 62140 (or 62141). CPT 15769 is for excision of an autologous graft, such as abdominal fat, so you could not use this code for a synthetic graft. In fact, there is no separate coding for repairing the dura with a synthetic graft – it is part of the primary procedure code, 61520. Lastly, 15733 for the muscle flap would also not be used for a “flap closure” as this also was part of the usual closure.

*This response is based on the best information available as of 04/21/22.

Tendon Repair

Question:

I am new to orthopaedic hand coding. I have a case where the surgeon repaired two flexor tendons in the finger. I am being told that I may only report one CPT code because they were both repaired via the same incision. Is this correct? The surgeon, who is new, disagrees and says both repairs are reportable.

Answer:

The surgeon is correct and kudos to you for reaching out to verify what you were told.
It will be important to know if the repairs were “in zone 2” or “not in zone 2”..

To illustrate why the information you were given was incorrect, let’s look at the description of CPT code 26356 as an example.

Note in the description there are several important pieces of information:

Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man’s land); primary, without free graft, each tendon
1. This code is used for the repair or advancement of a flexor tendon
2. The tendon is in zone 2
3. The last part of the code descriptor states “each tendon”

Some payors may allow you to report two, or multiple tendon repairs of the same type using units, while others may require the use of distinct services modifier 59 to indicate that the second (or subsequent) code represents repair of a different tendon. CMS does not allow modifier 59 on a duplicate CPT code.

Option 1: 26356 x 2
Option 2: 26356, 26356-59

When tendons are repaired in the fingers, you could also use finger modifiers FA-F9 to designate the specific finger location.

Good luck and please let us know if the KZA Orthopaedic Consulting team may be of assistance with future coding questions. You may contact Milka Djukic at
mdjukic@karenzupko.comfor information related to hourly consulting services to assist with operative note reviews, coding or practice management questions.

Gender Reassignment “Top” Surgery Coding

Question:

We are having a debate on whether to use a mastectomy code or breast reduction code for “top” female-to-male procedures. What’s your advice?

Answer:

Unfortunately, we do not have a specific CPT code(s) for these procedures as the existing codes were not written with these procedures in mind. Our advice is to consult the payor’s medical coverage policy and determine the payor’s preference for how to code for the procedure you’re performing.