Billing for Costotransversectomy

Question:

If the exposure is thoracic, for example in a thoracic corpectomy, and the documentation states a costotransversectomy was performed, can that be billed separately?

Answer:

Costotransversectomy (e.g., 21610) is included in a thoracic corpectomy and not separately billed. Note also that 21610 states “separate procedure” so it is never billed with a more inclusive code.

*This response is based on the best information available as of 08/25/22.

Billing for Intraoperative Injury

Question:

A major blood vessel was accidentally nicked while a general surgeon was performing a complex case. A vascular surgeon was called in to repair the blood vessel. Since they are different specialties, can the vascular surgeon bill for the repair, even though she is in the same group as the general surgeon?

Answer:

Yes, if both surgeons are different specialties and designated with separate taxonomy number (General Surgery and Vascular Surgery are) then the vascular surgeon should bill for the repair.

*This response is based on the best information available as of 08/25/22.

2021 Evaluation and Management Codes: Is a History Required?

Question:

My coder just told me about the new guidelines for 2021 office visit codes. She said I no longer have to document a History. This doesn’t seem right to me.

Answer:

You are wise to ask because that’s not exactly true. It is correct that the History will no longer be used to select a new patient (9920x) or established patient (9921x) visit code. However, it is expected that you will document a “medically appropriate” (per CPT™ history for each encounter.

2021 E/M Guidelines and Consultation Codes

Question:

I am new to an Orthopaedic practice where the coders do all the coding. The current coding staff is applying the 2021 E&M Guidelines to all encounters in the office; new, established and consultations (where the payors still recognize consultations). Is this correct? We did not do that in my former practice. I want KZA’s opinion before I bring this to the manager.

Answer:

Thanks for contacting KZA and we appreciate your support of our consultant’s expertise in Orthopaedic coding. You are correct to question this and hope this answer is timely for you to take to your manager. Today, in 2022, the 2021 E/M guidelines are for office/outpatient visit codes only (99202-99215). Consultation services or any other E&M service that does not meet the new/established patient definition will be coded with the 1995/1997 guidelines.

Congratulations on your new job—they will appreciate having you on board.

Billing for Lesion Intervention Crossing Territories

Question:

Our vascular surgeon documented a single intervention for a lesion that crosses the margin between the fem/pop and tibial/peritoneal territories. Should we bill one code or one for each territory?

Answer:

You would bill one code since a single intervention was performed, even though it crossed into another territory.

Attempted Foreign Body

Question:

When billing a foreign body removal code of 10120, the surgeon incises the finger and looks around for 25 mins and no foreign body is found, do we bill a 52 since no FB was found or do we bill the 10120 without the modifier since the provider did perform the procedure? I can’t seem to find any guidance on this. Can you help?

Answer:

Make sure that the physician documented that the incision was within thesubcutaneous tissue (required for CPT 10120).  When a procedure is considered to have ‘failed,’ specifically the expected result of the procedure is not achieved, the procedure is coded as performed.  You should report the procedure with Modifier 52 anddue to the fact that there was no foreign body discovered, the service was reduced. Using modifier 52 provides a means of reporting reduced services without disturbing the identification of the basic service.

*This response is based on the best information available as of 08/25/22.