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Removal of Ventricular Catheter
What code would be used for removal of a ventricular catheter?
Question:
What code would be used for removal of a ventricular catheter?
Answer:
There is no code for ventricular catheter removal, it is included in the placement as it is expected to be removed.
*This response is based on the best information available as of 7/11/24.
Transcutaneous Magnetic Nerve Stimulation
How is this service reported, we are having trouble locating a CPT code, should we use an unlisted code?
Question:
How is this service reported, we are having trouble locating a CPT code, should we use an unlisted code?
Answer:
This service should not be reported with an unlisted code.New Category III codes were created in 2023 to report transcutaneous magnetic nerve stimulation of peripheral nerve by focused low frequency electromagnetic pulse with noninvasive electroneurographic localization. This new technology is used in the management of chronic pain following a traumatic injury. The treatment is repeated over several months. Injured nerve is localized using magnetic stimulation at the time of the initial treatment. The skin is marked with photographic record to facilitate rapid localization of the correct site for subsequent treatments and the appropriate amplitude of magnetic stimulation.
Nerve conduction may be used as guidance to confirm precise localization of the injured nerve but is not separately reported as a diagnostic study. If a separate diagnostic nerve conduction study is performed prior to the decision to treat with transcutaneous magnetic stimulation, then it may be reported separately.
0766T Transcutaneous magnetic stimulation by focused low frequency electromagnetic pulse, peripheral nerve, initial treatment, with identification and marking of the treatment location, including noninvasive electroneurographic location (nerve conduction location) when performed; first nerve
+0767T Each additional nerve (List separately in addition to code for primary procedure
*This response is based on the best information available as of 7/11/24.
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.
