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Consultation Coding in 2023
In 2023, will the level of service be determined by history, exam and medical decision making, or will this change? I have heard it is changing.
Question:
In 2023, will the level of service be determined by history, exam and medical decision making, or will this change? I have heard it is changing.
Answer:
Beginning January 1, 2023, consultation codes 99242-99255) for both inpatient and outpatient services will be based on medical decision making or time. However, keep in mind a clinically relevant history and clinical examination should also be documented. Also, consultation codes 99241 and 99251 have been deleted.
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.
*This response is based on the best information available as of 12/15/22.
Consultation Coding in 2023
In 2023, will the level of service be determined by history, exam and medical decision making, or will this change? I have heard it is changing.
Question:
In 2023, will the level of service be determined by history, exam and medical decision making, or will this change? I have heard it is changing.
Answer:
Beginning January 1, 2023, consultation codes 99242-99255) for both inpatient and outpatient services will be based on medical decision making or time. However, keep in mind a clinically relevant history and clinical examination should also be documented. Also, consultation codes 99241 and 99251 have been deleted.
*This response is based on the best information available as of 12/15/22.
Consultation Coding in 2023
In 2023, will the level of service be determined by history, exam and medical decision making, or will this change? I have heard it is changing.
Question:
In 2023, will the level of service be determined by history, exam and medical decision making, or will this change? I have heard it is changing.
Answer:
Beginning January 1, 2023, consultation codes 99242-99255) for both inpatient and outpatient services will be based on medical decision making or time. However, keep in mind a clinically relevant history and clinical examination should also be documented. Also, consultation codes 99241 and 99251 have been deleted.
Debridement Coding
If 10 sq. cm subcutaneous tissue is debrided from the right leg and 20 sq. cm is debrided from the left leg, is it coded as 11042 and 11042-59 or 11042 RT and 11042 LT?
Question:
If 10 sq. cm subcutaneous tissue is debrided from the right leg and 20 sq. cm is debrided from the left leg, is it coded as 11042 and 11042-59 or 11042 RT and 11042 LT?
Answer:
If debridement is performed at the same depth of tissue (all subcutaneous tissue) it is summed to arrive at the appropriate codes, even if in different anatomic areas. So, in your example, the codes would be 11042 and the add-on code 11045 for the 30 sq. cm of debridement. See the codes below.
11042 Debridement,subcutaneous tissue(includes epidermis and dermis, if performed); first 20 sq. cm or less
11045 each additional 20 sq. cm, or part thereof (List separately in addition to code for primary procedure)
*This response is based on the best information available as of 12/15/22.
Consultation Coding in 2023
In 2023, will the level of service be determined by history, exam and medical decision making, or will this change? I have heard it is changing.
Question:
In 2023, will the level of service be determined by history, exam and medical decision making, or will this change? I have heard it is changing.
Answer:
Beginning January 1, 2023, consultation codes 99242-99255) for both inpatient and outpatient services will be based on medical decision making or time. However, keep in mind a clinically relevant history and clinical examination should also be documented. Also, consultation codes 99241 and 99251 have been deleted.
*This response is based on the best information available as of 12/15/22.
