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Billing for Comparison Views
Can we bill comparison in-office x-ray views (usually knees or elbows) if the patient is asymptomatic on the contralateral (opposing) side?
Question:
Can we bill comparison in-office x-ray views (usually knees or elbows) if the patient is asymptomatic on the contralateral (opposing) side?
Answer:
Unless there is a medically necessary reason for the comparison views on the contralateral body part, they should not be billed separately. If documentation does support billing for both sides, select the CPT by number of views and add the appropriate modifier (e.g., 3 views of the left knee and 2 views of the right knee 73562 LT and 73560 RT).
Coding for a Chiari Malformation
Is there a code for a craniotomy for decompression for Chiari? And the surgeon also did a C1 laminectomy. Is that a separate code?
Question:
Is there a code for a craniotomy for decompression for Chiari? And the surgeon also did a C1 laminectomy. Is that a separate code?
Answer:
The code for a decompressive craniotomy for Chiari is 61343 and includes the work of the cervical laminectomy.
*This response is based on the best information available as of 03/16/23.
Adjacent Tissue Transfer
How should my physician document an adjacent tissue transfer? My physician documents the total in sq cm for the entire repair.
Question:
How should my physician document an adjacent tissue transfer? My physician documents the total in sq cm for the entire repair.
Answer:
The primary and secondary defect dimensions are required. The primary defect is the excision site and the secondary defect results from the flap design to perform the reconstruction. So documentation in the operative report must include:
- Primary defect-sq cm
- Secondary defect sq cm
- Primary defect sq + secondary defect sq cm=CPT code
Adjacent Tissue Transfer
How should my physician document an adjacent tissue transfer? My physician documents the total in sq cm for the entire repair.
Question:
How should my physician document an adjacent tissue transfer? My physician documents the total in sq cm for the entire repair.
Answer:
The primary and secondary defect dimensions are required. The primary defect is the excision site and the secondary defect results from the flap design to perform the reconstruction. So documentation in the operative report must include:
- Primary defect-sq cm
- Secondary defect sq cm
- Primary defect sq + secondary defect sq cm=CPT code
*This response is based on the best information available as of 03/16/23.
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.
Billing for an Iatrogenic Injury, Not my Patient (Stage 1)
My surgeon was called to the OR by an OB-GYN who accidently lacerated the small bowel during an open gynecological procedure. She repaired the small bowel with sutures. How is this billed, is my surgeon a co or assistant surgeon?
Question:
My surgeon was called to the OR by an OB-GYN who accidently lacerated the small bowel during an open gynecological procedure. She repaired the small bowel with sutures. How is this billed, is my surgeon a co or assistant surgeon?
Answer:
Neither. Repairing the bowel is not inherent to a gynecological procedure so your surgeon would not be a co or assistant surgeon. Instead she will bill for the work she performed, code 44602,Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture; single perforation.
*This response is based on the best information available as of 03/16/23.
