Nursing Visit on the Same Day as Allergy Injections

Question:

Can you bill a nursing visit when a patient comes in for an allergy injection?

Answer:

The routine preinjection and post injection evaluations by the nurse or MA would be included in codes 95115-95117 and would not be eligible to report separately.

When documentation supports that a significant, separately identifiable evaluation and management (E/M) service was rendered, the appropriate E/M code for the service may be reported. All care directly related to the administration of the injection, i.e., the injection cannot be administered without the preinjection and post injection check by the nurse.

However, if the nurse/MA provided any care unrelated to the injection, then code 99211 may be separately reported with modifier 25. However, such instances would be rare, and documentation would need to support both the service and its medical necessity.

*This response is based on the best information available as of 11/03/22.

SI Joint Injection

Question:

What CPT code do we use when our physician performs an SI joint injection using ultrasound guidance? CPT code 27096 states with fluoroscopy or CT guidance.

Answer:

CPT instructs to report CPT code 20552 for unilateral or bilateral SI joint injections if CT or Fluoroscopic imaging is not used. CPT code 76942, for the ultrasound guidance, may be reported if the documentation requirements are met.

source: CPT Assistant April 2022

Dialysis Circuit Revision

Question:

My vascular surgeon performed a dialysis circuit open revision, and had to remove subcutaneous fat during the procedure. He said this was a more complex procedure than usual, so is there another code to use besides 36832?

Answer:

Removing excess subcutaneous fat is included in the work for 36832, so this is the only appropriate code for an open revision without a thrombectomy.

Coding for Trigeminal Neuralgia #3

Question:

How is RFA rhizotomy of the trigeminal nerve at the second and third division branches of the foramen ovale reported ? The diagnosis was Trigeminal Neuralgia.

Answer:

This procedure is coded as 64605, Destruction by neurolytic agent, trigeminal nerve second and third division branches at foramen ovale .Code +77002 may also be reported if fluoroscopy is used, documented, and a permanent image is retained.

*This response is based on the best information available as of 11/03/22.

Soft Tissue Tumor Excisions

Question:

My physician performed two soft tissue tumor excisions in different areas on the scalp. They measured 1.0 cm and 1.5 cm. Can I bill for both? Also can I report a layered closure.

Answer:

You would report CPT 21011 (excision soft tissue tumor, scalp 2cm or less) for the first excision and 21011-59. Modifier 59 is used to indicate a completely separate procedure was performed using the same CPT code to avoid a claim denial for “duplicate charge. The repair is included in the global package for the excisions and not separately reported.

Laparoscopic Pyloroplasty

Question:

How is a laparoscopic pyloroplasty reported? Can I use code 43800, Pyloroplasty?

Answer:

No, codes without the term laparoscopic in their description are intended as open codes and 43800 is an open code. There is no laparoscopic code for pyloroplasty so an unlisted code 43659 unlisted laparoscopic procedure, stomach, must be used.

*This response is based on the best information available as of 11/03/22.