Repair of Nasal Valve Collapse

Question:

I perform repairs of nasal valve collapse with radiofrequency and have been using an unlisted code. One of my colleagues told me there is a new code for this procedure in 2023. Can you provide the code I need to use?

Answer:

In 2023 a new code was added. CPT 30469 is the correct code to report a nasal valve collapse with low energy temperature controlled subcutaneous/submucosal remodeling which includes radiofrequency.

*This response is based on the best information available as of 02/02/23.

What does “Separate Procedure“ Mean in a CPT Code Description?

Question:

What does “separate procedure” mean when it follows a CPT code description?

Answer:

Per CPT:Some of the procedures or services listed in the CPT codebook that are commonly carried out as an integral component of a total service or procedure have been identified by the inclusion of the term “separate procedure.” The codes designated as “separate procedure” should not be reported in addition to the code for the total procedure or service of which it is considered an integral component.

However, when a procedure or service that is designated as a “separate procedure” is carried out independently or considered to be unrelated or distinct from other procedures, report the code in addition to other procedures/services by appending modifier 59 to the specific “separate procedure” code. This indicates that the procedure is not considered to be a component of another procedure, but is a distinct, independent procedure. This may represent a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries).

What does this mean in practice?If a code description includes the term “separate procedure”, if that procedure is in the same anatomic area as a more comprehensive procedure (for example, lyse of adhesions followed by a colectomy) only the more comprehensive procedure, the colectomy, is reported.

Modifier 78 vs 59

Question:

What modifier do we use if a patient is returned to the OR the same day as the original surgery for post-op hemorrhage? Isn’t it 78 for this complication?

Answer:

Modifier 78 is a global period modifier and the global period begins on post-op day one. So it is not appropriate for a same day procedure. One of the uses of Modifier 59 and the specific use XE modifier is to report a bundled procedure done at a different session on the same calendar day. For this scenario, returning to control hemorrhage on the same day as the surgery, 59 or XE is the correct modifier.

*This response is based on the best information available as of 02/02/23.

Nonselective or Selective

Question:

When does a nonselective catheterization become a selective catheterization?

Answer:

If the catheter (not just the wire) is manipulated into another vessel beyond the puncture site or beyond the aorta, then it is coded as a selective catheterization.

29855 or 0707T?

Question:

Our surgeon documented in the procedure title that he performed an arthroscopic ORIF of a tibial plateau subchondral fracture with injection of calcium phosphate, and he wants to report CPT code 29855(Arthroscopically aided treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed (includes arthroscopy). I do not see an actual ORIF but do see the injection of the calcium phosphate.

I believe I read somewhere that this is not correct, but I cannot find my source.

Answer:

You are correct to question this and yes, CPT has addressed this several times in their AMACPT Assistantpublication in recent years. In 2019, they advised that CPT code 29855 is not the correct code for the brief description you provide.

In January 2022, CPT published Category III code 0707T(Injection(s), bone substitute material (eg, calcium phosphate) into subchondral bone defect (ie, bone marrow lesion, bone bruise, stress injury, microtrabecular fracture), including imaging guidance and arthroscopic assistance for joint visualization)as the code to use to report this work.

Consultations in 2023

Question:

I am putting together E&M Guideline educational information for my providers based on the 2023 changes for reference throughout the year. I did some education in 2022 and now working on the tools. In 2022, I kept hearing that inpatient and outpatient consultation codes were being deleted. However, they are still listed in the 2023 CPT Manual. Are you able to help me?

Answer:

You are correct; the inpatient and outpatient consultation services (i.e. 99242-99245 and 99252-99255) remain valid CPT codes in 2023. Perhaps the point of confusion is that CPT codes 99241 and 99251 were deleted to align the Medical Decision Making (MDM) levels with the levels that were defined in 2021 for the office outpatient codes and the 2023 hospital changes.

Remember, Medicare does not accept consultation codes and nothing changes for Medicare in 2023; the consultation codes in the Medicare fee schedule continue to have an Invalid code status. Some private payors have published guidelines stating they do not allow payment for consultations, but the codes remain current; there are payors who still recognize consultation codes.