Thyroidectomy

Question:

I did a right thyroidectomy 10 days ago and used CPT code 60220. I sent the specimen for analysis.  The pathology came back positive for thyroid cancer, and I had to perform a completion thyroidectomy on the left.  How would I code this?  Do I code the thyroidectomy code again 60220?

Answer:

You could code a completion thyroidectomy CPT 60260 (thyroidectomy, removal of all remaining thyroid tissue following previous removal of a portion of thyroid).  Ensure you also append Modifier 58 (staged or related procedure) since you are within the global 90-day period.  

*This response is based on the best information available as of 3/14/24.

Biopsy on the Same Date as Mohs

Question:

A patient came in for Mohs surgery, but there was no pathology report, so I had to do a biopsy before Mohs surgery.  Can I report the biopsy on the same date as the Mohs surgery?

Answer:

It is standard practice that a confirmed pathology report is available before Mohs surgery. You can bill a biopsy code on the same date as Mohs under the following conditions: 

• There is no previous biopsy on the same lesion within 60 days. 

• No pathology report available. 

• When biopsy and Mohs procedure are on separate sites. 

Ensure that a pathology report that does not exist or cannot be located is well documented.  In addition, You would report a biopsy code 11102, 11104, or 11106, depending on the biopsy method, plus 88331 for the frozen section pathology. Modifier 59 needs to be appended to each code to indicate that the biopsy was distinct and separate.   

*This response is based on the best information available as of 3/14/24.

Selective Debridement of Multiple Ulcers

Question:

Selective debridement was performed on 3 separate ulcers, 3 ulcers of the distal legs; 2 are on the right leg and 1 is on the left leg. Depth and size of debridement is documented as 

1. 15 sq cm, skin, subcutaneous tissue and muscle, right leg 

2. 10 sq cm, skin, subcutaneous tissue and muscle, left leg 

3. 10 sq cm, skin, subcutaneous tissue, muscle, and bone 

How is this reported? 

Answer:

Selective debridement of ulcer of the same depth are added together, regardless of their location. So, in the above scenario, the debridement of subcutaneous tissue and muscle are summed, for a total of 25 square centimeters. This is reported as codes, 11043 Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or and +11046 each additional 20 square cm or part thereof.  

The additional 10 square centimeter to a depth to bone are reported with code 11044, Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less.  

*This response is based on the best information available as of 3/14/24.

Denials for Initial Hospital Care and Observation E/M Codes: 2024

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 3/14/24.

New to Pain Management

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

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.