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Micromatrix
I'm new to plastics coding and have seen a couple of cases in which Acell Micromatrix is being documented. I have conflicting recommendations on whether to report this with a code from the 1527x series in CPT. However, I'm not confident with the advice. I am seeking an expert opinion and realize I should have started with KZA. Two questions: 1) is this separately reportable and 2) if yes, is CPT code 15271 the correct code?
Question:
I'm new to plastics coding and have seen a couple of cases in which Acell Micromatrix is being documented. I have conflicting recommendations on whether to report this with a code from the 1527x series in CPT. However, I'm not confident with the advice. I am seeking an expert opinion and realize I should have started with KZA. Two questions: 1) is this separately reportable and 2) if yes, is CPT code 15271 the correct code?
Answer:
No, this is not separately reportable according to CPT Guidelines in the treatment of open wounds. Acell Micromatrix is a micronized particle (powder) and is considered a non-graft wound dressing. The CPT Guidelines for skin substitute grafts (page 100 of the 2024 CPT manual) instruct you to use the codes for biological products that form a sheet scaffolding to promote skin growth. CPT instructs the skin substitute codes are not to be used for non-graft dressings such as the Acell Micromatrix, a powder. KZA appreciates your inquiry as these codes are always under scrutiny. If you are in the office setting (non-facility) and purchased the Micromatrix, you may look to report HCPCS code Q4118 for the supply purchased and the application of the non-graft wound dressing would be captured in the appropriate evaluation and management level code.
*This response is based on the best information available as of 7/11/24.
Can we Bill Co-surgeon if Called in to OR by Another Specialty for a Separate Procedure?
Our vascular surgeon was called into the OR by an orthopedic surgeon who was treating a patient for a traumatic injury of the lower left extremity as the result of an MVA. While stabilizing an open tib-fib fracture the ortho surgeon identified a transected posterior tibial artery and called the vascular surgeon for an intra-operative consult. The vascular surgeon quickly repaired the injured artery and then turned the patient back over to the ortho surgeon. Can we bill the vascular surgeon as co-surgeon?
Question:
Our vascular surgeon was called into the OR by an orthopedic surgeon who was treating a patient for a traumatic injury of the lower left extremity as the result of an MVA. While stabilizing an open tib-fib fracture the ortho surgeon identified a transected posterior tibial artery and called the vascular surgeon for an intra-operative consult. The vascular surgeon quickly repaired the injured artery and then turned the patient back over to the ortho surgeon. Can we bill the vascular surgeon as co-surgeon?
Answer:
No; co-surgery involves both surgeons performing integral portions of the same procedure (CPT code). In this case, the vascular surgeon is the only one repairing the injured vessel so the vascular surgeon would document his/her own op note with the details of the vascular procedure and code accordingly (likely CPT code 35226).
*This response is based on the best information available as of 6/20/24.
Diagnosis Coding Excludes 1 Codes
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.
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. Great news to hear you are reviewing your claims edit reports timely. The “Excludes 1” is an ICD-10 coding guideline or a coding rule. Think of this like an NCCI edit; when CMS has an edit between 2 CPT codes, we do not change the documentation in the operative note, for example, we report the most comprehensive of the 2 CPT codes. The “Excludes 1” guideline is a similar concept—we do not change the documentation; we report the most comprehensive diagnosis code.
*This response is based on the best information available as of 6/20/24.
Umbilical Hernia Repair with another Laparoscopic Procedure
When our surgeon is performing a non-hernia laparoscopic procedure and a port is placed in the umbilicus, can we also code to repair a known asymptomatic umbilical hernia at the same time as the non-hernia laparoscopic procedure?
Question:
When our surgeon is performing a non-hernia laparoscopic procedure and a port is placed in the umbilicus, can we also code to repair a known asymptomatic umbilical hernia at the same time as the non-hernia laparoscopic procedure?
Answer:
No; when a laparoscopic port is placed at the umbilical site, the repair of the umbilical hernia would be considered included and not separately reported.
*This response is based on the best information available as of 620/24.
Platelet Rich Plasma (PRP) Injections
What codes should we be reporting when we do PRP injections in our office?
Question:
What codes should we be reporting when we do PRP injections in our office?
Answer:
Code 0232T, Injection (s), platelet rich plasma, any site, with image guidance, harvesting and preparation when performed, is used to report this procedure. A PRP injection is bundled into the tendon sheath, trigger point, and joint injection CPT codes, thus, these codes should not be coded in addition to 0232T. Code 0232T is only reported when it is the only procedure performed. As a Category III code, it is not valued by Medicare (has 0 RVUs assigned), so payment is problematic, and most Medicare carriers do not pay for PRP. Billing a PRP injection as a trigger point injection is a misrepresentation of the actual service provided.
*This response is based on the best information available as of 6/20/24.
Arthrodesis Codes for Reporting Both Thoracic and Lumbar
Our neurosurgeon performed arthrodesis on a patient from T11 – L3 and we coded as 22612, 22610 and 22614 x2 and 22610 is being denied; can we add modifier 59?
Question:
Our neurosurgeon performed arthrodesis on a patient from T11 – L3 and we coded as 22612, 22610 and 22614 x2 and 22610 is being denied; can we add modifier 59?
Answer:
No; CPT codes 22610 and 22612 are both primary codes, and should not be reported together, if performed at the same operative session. Correct reporting of an arthodesis that crosses a spinal junction, is reported with one primary code and all other interspaces reported with the additional interspace code +22614.
Select a primary code where most of the work is performed, in this case, lumbar. So report 22612 as the sole primary code and 22614 x 3 for the additional interspaces.
*This response is based on the best information available as of 6/20/24.
