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Biopsy Coding
I work at an ENT clinic and my physician is doing biopsies of the soft palate and I’m not sure if this is coded as 11104 or goes under biopsy vestibule of mouth 40808? Thank you so much for your help with this!
Question:
I work at an ENT clinic and my physician is doing biopsies of the soft palate and I’m not sure if this is coded as 11104 or goes under biopsy vestibule of mouth 40808? Thank you so much for your help with this!
Answer:
If the physician is doing a biopsy of the soft palate you should report 42100 (biopsy of palate, uvula.) This CPT code is reported when the physician performs a biopsy on a lesion of the palate or uvula.
*This response is based on the best information available as of 10/10/22.
Co Surgeon or Assistant?
A vascular surgeon is requested to come to the OR to repair a blood vessel that my surgeon inadvertently nicked during a colectomy. Is he a co-surgeon or assistant on the case?
Question:
A vascular surgeon is requested to come to the OR to repair a blood vessel that my surgeon inadvertently nicked during a colectomy. Is he a co-surgeon or assistant on the case?
Answer:
Neither. The vascular surgeon will report his work, repair of vessel, and you will report yours.
*This response is based on the best information available as of 10/06/22.
Confusion About New 2021 E/M Guidelines
The new guidelines that are coming out in 2021 for all types of E/M services, right?
Question:
The new guidelines that are coming out in 2021 for all types of E/M services, right?
Answer:
No. The new guidelines are for office/outpatient visit codes only (99202-99215). You will still need to use the current guidelines for all other E/M services, even consultations in the office. But good news, the new 2021 guidelines will be used for all E/M codes as of 1/1/2023.
Counting Laminectomy Levels
I am confused and hoping you can clarify a coding question I have. I thought I understood how to report laminectomy levels, however, after recently reading an article in the AHA Coding Clinic HCPCS Volume 22, Number 2 Second Quarter 2022 publication, I doubt myself. The surgeon performs and documents a L2, L3, L4 laminectomy with decompression (lateral recess). I have always coded this as 63047, and one unit of 63048. The coding publication I was reading states to report 63047 and 2 units of 63048. Have I been coding incorrectly by only reporting one unit of 63048?
Question:
I am confused and hoping you can clarify a coding question I have. I thought I understood how to report laminectomy levels, however, after recently reading an article in the AHA Coding Clinic HCPCS Volume 22, Number 2 Second Quarter 2022 publication, I doubt myself. The surgeon performs and documents a L2, L3, L4 laminectomy with decompression (lateral recess). I have always coded this as 63047, and one unit of 63048. The coding publication I was reading states to report 63047 and 2 units of 63048. Have I been coding incorrectly by only reporting one unit of 63048?
Answer:
Thank you for contacting KZA for clarification. We understand your concern when reading various publications and seeing articles that are not consistent with what you thought you knew.
Without seeing an actual operative note, we agree with how you have coded this type of case in the past. Let’s take a look why.
CPT code 63047 is defined as “Laminectomy, facetectomy and foraminotomy (unilateral or bilateral) with decompression of spinal cord, cauda equina and/or nerve root(s), (e.g., spinal or lateral recess stenosis)),single vertebral segment; lumbar”
A “vertebral segment” means per motion segment. The decompression of the existing nerve root is performed in the interspace between the two lamina.
L2, L3, L4 when looked at closely defines two motion segments:
L2-3 =63047
L3-4= 63048 x 1 unit.
To report a third unit of 63048, the surgeon would either have had to go “up a level” to L1-L2, or “down a level” to L4-5.
We appreciate your verifying your coding practices.
Secondary Payor Doesn’t Recognize Consultations
We have a patient with 2 commercial payers (BCBS and Cigna). A consultation code was submitted to BCBS, and they paid according to our contract. However, Cigna is refusing to process the claim since they no longer pay for consult codes. Am I allowed to change the CPT code and rebill Cigna? Or would I need to change the CPT, refile to the primary as a corrected claim, then send the balance on to Cigna?
Question:
We have a patient with 2 commercial payers (BCBS and Cigna). A consultation code was submitted to BCBS, and they paid according to our contract. However, Cigna is refusing to process the claim since they no longer pay for consult codes. Am I allowed to change the CPT code and rebill Cigna? Or would I need to change the CPT, refile to the primary as a corrected claim, then send the balance on to Cigna?
Answer:
We suggest calling CIGNA and ask how they want this handled according to their policies. WithMedicareyou have two options: (1) bill the appropriate category and level of service documented (e.g., for outpatient consults [99202-99215] or inpatient consults [99221-99223]) or (2) bill the consultation code, which will result in a denial of payment from Medicare and appeal on paper explaining the situation.
Coding for Trigeminal Neuralgia #1
A retrosigmoid craniotomy was performed with microvascular decompression of the 5th nerve. The diagnosis was Trigeminal Neuralgia. How is this coded?
Question:
A retrosigmoid craniotomy was performed with microvascular decompression of the 5th nerve. The diagnosis was Trigeminal Neuralgia. How is this coded?
Answer:
This procedure is reported with code 61458,Craniotomy, suboccipital, for exploration or decompression of cranial nerves.
*This response is based on the best information available as of 10/06/22.
