Submucosal Repair with Lateral Wall Implants

Question:

What code do I use for a unilateral repair of a nasal valve collapse with submucosal wall implants on one side?

Answer:

You would report CPT code 30468 (Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implant(s)).  You will need to append Modifier 52 (reduced services) to 30468 since the procedure was performed unilaterally, and CPT code 30468 is a bilateral procedure. 

*This response is based on the best information available as of 3/28/24.

Sphenopalatine Ganglion Block

Question:

How do I report a ganglion impar injection of Depo-Medrol and Lidocaine? 

Answer:

The most appropriate code for this procedure is unlisted. However, as with all pain injections, check your payor policies. Some policies consider a ganglion impar injection, specifically for rectal or pelvic pain, as not medically necessary. Others allow payment with an unlisted code. Using an existing code such as 64450, other peripheral nerve, without knowing the payor’s policy may get reimbursed inappropriately.

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

Diagnosis Coding Excludes 1 Codes

Question:

Our physicians list their diagnosis codes in the Assessment section of their notes. They link the diagnosis codes to the charges in our EHR.   We receive a claims submission edit stating the two diagnosis codes may not be reported together. We review the rules and find the codes have an “Excludes 1” relationship.  Our question is, should we remove the diagnosis code that is listed as the “Excludes 1” from the Assessment section of the note when correcting the claim based on the guidelines.     

Answer:

No, we should never change anything in the provider documentation or remove information from the provider’s assessment and plan.  Great news to hear you are reviewing your claims edit reports timely and it appears your edit is set up correctly in your system.  The “Excludes 1” is an ICD-10 coding guideline or a coding rule found in the Conventions for the ICD-10-CM.  A type 1 Excludes note is a pure excludes note.  It means “NOT CODED HERE”. An Excludes 1 indicates that the code excluded should never be used at the same time as the code above the Excludes 1 note.  An Excludes 1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.  For the complete information and definition of Excludes Notes please refer to Section 1A Conventions for the ICD-10-CM #12. 

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

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.