Removal of Eschar

Question:

My plastic surgery saw a patient who sustained an approximately 40% total body surface area burn in a fire. He has previously undergone excision and allograft placement of his extremities. He now came back for removal of the eschar that remains present on his torso and bilateral thighs. The total area excised was 5275 sq cm. How would I code this?

Answer:

You will report CPT code 15002 (surgical preparation) for the first 100 sq cm and 15003 for each additional 100 sq cm. CPT code 15003 is reported with 52 units.

Secondary Payor Doesn’t Recognize Consultations

Question:

We have a patient with 2 commercial payers (BCBS and Cigna). A consultation code was submitted to BCBS, and they paid according to our contract. However, Cigna is refusing to process the claim since they no longer pay for consult codes. Am I allowed to change the CPT code and rebill Cigna? Or would I need to change the CPT, refile to the primary as a corrected claim, then send the balance on to Cigna?

Answer:

We suggest calling CIGNA and ask how they want this handled according to their policies. WithMedicareyou have two options: (1) bill the appropriate category and level of service documented (e.g., for outpatient consults [99202-99215] or inpatient consults [99221-99223]) or (2) bill the consultation code, which will result in a denial of payment from Medicare and appeal on paper explaining the situation.

*This response is based on the best information available as of 05/25/23.

Facet Fusion

Question:

The neurosurgeon documents a placing a cervical “facet implant or intrafacet implant “ with bone graft. Is this coded as 22600, cervical arthrodesis?

Answer:

No. This is coded with a Category III code, as shown below:

Facet Wedge or Dowel Arthrodesis (Intrafacet Implant)

Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level

• Cervical: 0219T
• Thoracic: 0220T
• Lumbar: 0221T
• Additional level: +0222T
• Includes fluoroscopy and any radiological service.
• Includes bone graft, instrumentation and arthrodesis – do not report 0219T-0221T with +20930, +20931, 22600-22614, +22840, +22853, +22854, +22859 at the same level.

*This response is based on the best information available as of 05/25/23.

Is an Annular Repair Separately?

Question:

Our physician stated he was told at his prior hospital that he could report an annular repair with a discectomy.  We have told him this was inclusive but he is asking us to contact KZA.   Is the annular repair reportable in addition to the discectomy code? If yes, what CPT code would we report?

Answer:

Thank you for your inquiry.  Your response was accurate; it is unfortunate when physicians are given inaccurate coding device. While the hospital may be able to bill for closure devices, the work of repairing the annular defect is inclusive to the physicians work. Report the appropriate discectomy codes (e.g. 63020-63030)

Bone Anchored Hearing Implants

Question:

What CPT code would I report for implanting a bone anchoredosseointegratedimplant with a magnetic transcutaneous attachment outside of the mastoid?

Answer:

In 2023 three new CPT were created to report Transcutaneousosseointegratedimplants outside of the mastoid.  For the implantation the code to report is 69729, for the replacement of the existing device report 69630 and for the removal of the implant report 69728.

*This response is based on the best information available as of 05/25/23.

Billing for a Repair immediately Following Mohs Surgery

Question:

Can we bill for a simple repair when the surgeon performs Mohs?

Answer:

An intermediate or complex repair, flaps or grafts may be reported in addition to MMS.  The simple repair is included in the procedure and is NOT reported.

*This response is based on the best information available as of 05/11/23.