Choose your specialty from the list below to see how our experts have tackled a wide range of client questions.
Looking for something specific? Utilize our search feature by typing in a key word!
New to Pain Management
Pain Management is a brand-new service line for our practice, we have 20 Orthopaedic surgeons (one is interventional ortho/pain management). We just purchased a C-Arm and are using it in the office. The pain management surgeon was using this at the outpatient surgical facility. Is there anything specific regarding billing for the C-Arm for place of service 11 (office) that we should be aware of?
Question:
Pain Management is a brand-new service line for our practice, we have 20 Orthopaedic surgeons (one is interventional ortho/pain management). We just purchased a C-Arm and are using it in the office. The pain management surgeon was using this at the outpatient surgical facility. Is there anything specific regarding billing for the C-Arm for place of service 11 (office) that we should be aware of?
Answer:
KZA recommends that you reach out directly to the specific insurance carriers that you are contracted with regarding coverage and reimbursement of the C-Arm. Most pain management procedures include the use of C-Arm in the performance of the procedure and therefore, the use of the C-Arm would not be reported in addition. KZA also recommends you check your Medicare Administrative Contractor (MAC) for specific Local Coverage Determinations (LCDs) for any pain management procedures your clinic will be performing. The LCDs provide information regarding the coverage criteria, requirements, and medical necessity for the procedure(s).
*This response is based on the best information available as of 2/29/24.
Coding +34713
Can code 34713 for placement of a larger than 12 French sheath in endograft placement be reported with an open exposure of the same artery?
Question:
Can code 34713 for placement of a larger than 12 French sheath in endograft placement be reported with an open exposure of the same artery?
Answer:
No, add-on code +34713 is specifically for percutaneous placement. See code description below.
+34713 - Percutaneous access and closure of femoral artery for delivery of endograft through a large sheath (12 French or larger), including ultrasound guidance, when performed unilateral (List separately in addition to code for primary procedure)
*This response is based on the best information available as of 2/29/24.
DME Billing Inquiry
With Medicare, some of our patients come in on a different day other than the office visit to pick up their DME. Do we use the date they pick up the DME item or the date of the office visit for billing?
Question:
With Medicare, some of our patients come in on a different day other than the office visit to pick up their DME. Do we use the date they pick up the DME item or the date of the office visit for billing?
Answer:
The date of service for billing in this instance would be the date the DME is picked up (date of delivery to the patient).
*This response is based on the best information available as of 2/29/24.
Tongue Lesion Excision
My physician always bills a glossectomy CPT code 41120 when removing a lesion from the tongue. Is this correct?
Question:
My physician always bills a glossectomy CPT code 41120 when removing a lesion from the tongue. Is this correct?
Answer:
No this is not correct. The glossectomy codes require the removal of a portion or all of the tongue. When a lesion is removed report a code from CPT 41112-41114.
*This response is based on the best information available as of 2/29/24.
Repairs following Mohs Surgery
Our Mohs surgeons will sometimes perform an adjacent tissue transfer or a flap after Mohs surgery. They want to bill an E/M service with Modifier 57 since they decided to do the flap after Mohs. I don’t think this is correct. Can you help clarify?
Question:
Our Mohs surgeons will sometimes perform an adjacent tissue transfer or a flap after Mohs surgery. They want to bill an E/M service with Modifier 57 since they decided to do the flap after Mohs. I don’t think this is correct. Can you help clarify?
Answer:
The E/M service should not be reported after Mohs surgery when a decision is made for a repair, flap, or graft. Even though a flap has a 90-day global period, the surgical decision was made to perform Mohs, the primary procedure. The intent of the E/M with Modifier 57 for a procedure with a 90 global period is when the initial decision is made to perform the primary procedure. The repair is secondary; therefore, billing an E/M service is inappropriate. The discussion and recommendation for the repair is part of the pre-service work for the repair.
*This response is based on the best information available as of 2/29/24.
Denials for Initial Hospital Care and Observation E/M Codes: 2024
We are experiencing denials when we bill 99221-99223 and the place of service is observation (outpatient hospital). Are we doing something wrong?
Question:
We are experiencing denials when we bill 99221-99223 and the place of service is observation (outpatient hospital). Are we doing something wrong?
Answer:
You are billing correctly based on CPT 2023 guidelines for E/M that merged inpatient hospital encounters/codes with observation encounters/codes. Unfortunately, some payor claims processing systems may not yet recognize these changes as they apply to billing. You will have to appeal these denied claims, with CPT references showing the current guidelines for E/M reporting.
*This response is based on the best information available as of 2/29/24.
