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.

Removing a Nasal Pack

Question:

I have looked everywhere and cannot find a CPT code for removing a posterior nasal pack. I found CPT code 30906 for reporting control of a nasal hemorrhage when removing and replacing the pack. Can I report 30906 with Modifier 52 since my doctor is just removing the posterior nasal pack?

Answer:

No, you do not report 30906. There is not a code ore removing a posterior pack unless you are replacing the pack at the same time. If you are only removing a pact then report an E/M CPT code or nasal endoscopy code (31231) whichever is more appropriate.

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

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.