EVAR and Co-surgery

Question:

My vascular surgeon partner and I performed an EVAR together. Is this reported as co-surgery?

Answer:

Co-surgery is defined as two surgeons doing distinct and separate parts of a single CPT code. The intent is that the two surgeons have different skill sets; be of a different surgical specialty. You and your partner jointly performing an EVAR, would be reported as primary and assistant.

Gynecomastia

Question:

A 24-year-old male is seen in our office for gynecomastia. My physician did a bilateral resection of the glandular component and liposuction of the fatty components of his defect. I am new to coding for plastic surgery and not sure how to code this. Can you help?

Answer:

Of course. The CPT code reported is 19300-50 (Mastectomy for gynecomastia). Modifier 50 is used when the procedure is performed bilaterally. The diagnosis code to report is N62 (Hypertrophy of the breast).

Codes for Laminectomy for Lumbar Radiculopathy

Question:

For a patient with a diagnosis of lumbar  radiculopathy, the surgeon performed a L3-L4 laminectomy with bilateral   foraminotomy. She also removed some disc at the same level. Can both 63047 and 63030-59 be billed?

Answer:

For a laminectomy at a single interspace/motion segment, only one code may be reported. In the case described above, the laminectomy for stenosis, 63047, is the only code reported. The disc removal is inclusive. And remember, laminectomy codes are diagnosis driven. A more specific diagnosis for the cause of the radiculopathy stenosis for example, should be added.

*This response is based on the best information available as of 07/06/23.

Billing Two Hernias

Question:

The surgeon performed a laparoscopic repair of an initial strangulated ventral hernia and a laparoscopic repair of an inguinal hernia on the same day. Can the surgeon bill for both procedures?

Answer:

Yes, both procedures can be reported with codes 49592, 49594, or 49596, depending on size, and 49650,Laparoscopy, surgical; repair initial inguinal hernia.Because this code pair does not have a National Correct Coding Initiative edit, modifier 51,Multiple procedures, would be appended to the lower-valued code.

*This response is based on the best information available as of 07/06/23.

Radiology Reports

Question:

Earlier this year, I attended an education session (not provided by KZA) where radiology reports were discussed. We have been going to KZA courses for many years and have the workbook pages with the history of the requirement and definition change for reports. We were confident we knew the documentation requirements but thought maybe something has changed; we are coming back to KZA for clarification.

In the session, the presenter addressed the need for separate reports; but then said it would be okay if the interpretation was within the office note and not a separate report.

Is a separate report required or not when we report the global radiology codes or the radiology codes with a modifier 26? I just want to make sure nothing has changed.

Answer:

Thank you for your continued support of KZA. Yes, a separate stand-alone report with the professional interpretation (not just review of the X-Rays) is still required. Perhaps the presenter was talking about the documentation requirements when the professional interpretation of external diagnostic studies is documented as part of the E&M note; this interpretation is not separately reportable with a modifier 26; as such a separate stand-alone report is not required. All other interpretation requirements must still be met.

A separate stand-alone report is required if you are billing the global radiology codes or the radiology codes with a modifier 26.

Coding for Trigeminal Neuralgia

Question:

How is RFA rhizotomy of the trigeminal nerve at the second and third division branches of the foramen ovale? The diagnosis was Trigeminal Neuralgia

Answer:

This procedure is coded as 64605,Destruction by neurolytic agent, trigeminal nerve second and third division branches at foramen ovale.Code +77002 may also be reported if fluoroscopy is used, documented, and a permanent image is retained.