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Pharyngectomy Code
Do I use CPT code 42950 when a limited pharyngectomy is done??
Question:
Do I use CPT code 42950 when a limited pharyngectomy is done??
Answer:
No, you should report CPT code 42890 when a limited pharyngectomy is performed not CPT 42950 (Pharyngoplasty (plastic or reconstructive operation on pharynx).
*This response is based on the best information available as of 09/27/22.
2021 Evaluation and Management Codes: Is a History and Exam Required?
After a recent audit and review with my physicians, they are telling me that they do not need to document a history and/or exam any more for the new and established patients. That is not my understanding.
Question:
After a recent audit and review with my physicians, they are telling me that they do not need to document a history and/or exam any more for the new and established patients. That is not my understanding.
Answer:
You are wise to ask because that’s not exactly true; we hear it not infrequently. It is correct that the History or Exam will no longer be used to select a new patient (9920x) or established patient (9921x) visit code. However, it is expected that the physician/provider will document a “medically appropriate” (per CPT™) history and exam for each encounter.
In Orthopaedics, we find the History section to provide important information that assists with the Data Element sections in the MDM table. Items such as the location, duration of the problem, past treatments such as injections, documentation that external X-Rays were brought with the patient are helpful in determining the level of risk in addition to the remainder of the note.
Choosing a Modifier with a Colostomy Revision
What modifier is used to report a colostomy revision during the global period of the stoma creation?
Question:
What modifier is used to report a colostomy revision during the global period of the stoma creation?
Answer:
A modifier 78, return to the OR for a related procedure, in this case a complication of the creation, would be appended.
*This response is based on the best information available as of 09/22/22.
Coding a Decompressive Craniectomy
In a recent head trauma case, a decompressive craniectomy was performed with a partial temporal lobectomy, due to extensive damage. A hematoma was also evacuated. can we bill for the 61323 decompressive craniectomy code with lobectomy since only a partial lobectomy was done? And what about cooing for the hematoma evacuation?
Question:
In a recent head trauma case, a decompressive craniectomy was performed with a partial temporal lobectomy, due to extensive damage. A hematoma was also evacuated. can we bill for the 61323 decompressive craniectomy code with lobectomy since only a partial lobectomy was done? And what about cooing for the hematoma evacuation?
Answer:
For the procedure described, code 61323, decompressive craniectomy with lobectomy, may be reported, even with a partial lobectomy. The hematoma evacuation is included in code 61323.
*This response is based on the best information available as of 09/22/22.
Modifiers on Unlisted Codes. Yes or No?
Can I use modifiers on an unlisted code? What about global period modifiers such as 58, 78 or 79? It seems reasonable to append those modifiers to the unlisted code.
Question:
Can I use modifiers on an unlisted code? What about global period modifiers such as 58, 78 or 79? It seems reasonable to append those modifiers to the unlisted code.
Answer:
There is not a single right answer to this question. CPT said, in an old CPT Assistant, that generally modifiers are not appended to an unlisted code.
Payors have their own rules. For example, some payors will accept modifier 62 (two surgeons/co-surgery) on an unlisted code such as 64999 while other payors do not.
We would not append modifier 50 (bilateral procedure) 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.
We also would not append modifier 51 (multiple procedures) to an unlisted code. Let the payor take the discount.
Billing Multiple Units
When billing 4 units of 11620 (4 charges with 1unit a piece with 76 modifier) to a Medicare Advantage plans we are getting denied for MUE stating that 3 units can only be reimbursed on the same date. Will changing the modifier to 59 bypass this edit or is it Medicare’s policy limit.
Question:
When billing 4 units of 11620 (4 charges with 1unit a piece with 76 modifier) to a Medicare Advantage plans we are getting denied for MUE stating that 3 units can only be reimbursed on the same date. Will changing the modifier to 59 bypass this edit or is it Medicare’s policy limit.
Answer:
An MUE of 3 is the maximum number of units you can report for a single beneficiary on a single date of service for the procedure. It would be inappropriate to bill the service with 4 units with Modifier 59.
*This response is based on the best information available as of 09/22/22.
