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Portable Ultrasound Equipment
Our physician’s submitted literature to our administration team related to portable handheld ultrasound equipment for purchase consideration. I was asked if this equipment met CPT requirements for ultrasound. Is this equipment acceptable to use when performing ultrasound guided injections?
Question:
Our physician’s submitted literature to our administration team related to portable handheld ultrasound equipment for purchase consideration. I was asked if this equipment met CPT requirements for ultrasound. Is this equipment acceptable to use when performing ultrasound guided injections?
Answer:
We recommend you research the website literature for product specifications or contact the vendor. The key will be that the technology must be able to capture and save images in the medical record. The images will need to show the needle localized in the specific anatomic site.
CPT codes that state “with ultrasound guidance” (e.g. Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting) or codes such as CPT code 76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation) will not be reportable if the technology does not have the capacity to save the images to the medical record.
Venogram and Catheterization
During a catheterization the surgeon performed a venogram. I don’t see that these procedures are bundled, is that correct?
Question:
During a catheterization the surgeon performed a venogram. I don’t see that these procedures are bundled, is that correct?
Answer:
Venous catheterization codes are separately reported with venograms, unless they are performed at the same session with an intervention that includes catheterization.
Forehead Flap
Our plastic surgeon routinely does repairs after Mohs surgery. What CPT code do I report for a paramedian forehead flap to reconstruct a nasal defect after Mohs surgery.
Question:
Our plastic surgeon routinely does repairs after Mohs surgery. What CPT code do I report for a paramedian forehead flap to reconstruct a nasal defect after Mohs surgery.
Answer:
The correct code to report is CPT code 15731 (Forehead flap with preservation of vascular pedicle (e.g., axial pattern flap, paramedian forehead flap).
Billing for an Iatrogenic Injury, My Patient
The surgeon reported an intestinal perforation caused by a trocar during a laparoscopic cholecystectomy due to extensive adhesions. He completed the cholecystectomy and also did a suture repair of one perforation of the small intestine. How is this reported?
Question:
The surgeon reported an intestinal perforation caused by a trocar during a laparoscopic cholecystectomy due to extensive adhesions. He completed the cholecystectomy and also did a suture repair of one perforation of the small intestine. How is this reported?
Answer:
Iatrogenic, intraoperative complications that are repaired at the same operative session are not separately reported. Since the small bowel perforation was an iatrogenic injury, inadvertently done by the surgeon during a surgery, it is not reported. Only the cholecystectomy should be reported.
*This response is based on the best information available as of 03/02/23.
What Does “Separate Procedure” Mean in a CPT Code Description?
What does “separate procedure” mean when it follows 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.
*This response is based on the best information available as of 03/02/23.
Lumbar Drain in a Cranial Procedure
Can placement of a lumber drain be billed separately with a cranial procedure? I heard that placing drains is not billable.
Question:
Can placement of a lumber drain be billed separately with a cranial procedure? I heard that placing drains is not billable.
Answer:
You are correct that placement of a drain in the surgical site/exposure is not separately billable. Placing a lumber drain via a separate incision ( in the back) during a cranial procedure is billable as it is in a separate anatomic location.
Report code 62272 if placed without fluoroscopic guidance and 62329 if fluoroscopy is used. The fluoroscopy is not separately billed.
*This response is based on the best information available as of 03/02/23.
