Component Seperation

Question:

Our provider has documented abdominal closure by component separation, is there a separate CPT code for this closure or is it included in the main procedure?

Answer:

Component separation, sometimes referred to as a rectus advancement flap, refers to a myocutaneous flap of the trunk (a flap of subcutaneous tissue, fascia and muscle with an intact vascular supply) represented by CPT code 15734. To report this code the providers documentation must demonstrate that the oblique, transversalis or transverse abdominus and rectus abdominus muscles have been incised and mobilized toward the midline with an intact vascular supply. This code can be reported only once for each side and bilateral modifier does not apply, so when performed bilaterally report as 15734, 15734-59.​

*This response is based on the best information available as of 10/3/24.

Ultrasound Guidance for Vascular Access

Question:

What are the requirements to code 76937 for ultrasound guidance for vascular access? 

Answer:

CPT code 76937 requires documentation of the following: ultrasound evaluation of potential access sites, localization and documentation of vessel patency, and the permanent recording and report must be noted and stored. ​

*This response is based on the best information available as of 10/03/24.

Paraspinal Intramuscular Injections

Question:

The type of injections our physicians perform are best described as paraspinal intramuscular injections or paraspinal nerve blocks without radiographic guidance. We are unsure how to code this procedure. What is the best code to use?

Answer:

Any injection around the spine without imaging guidance is best described as a trigger point injection.  The number of muscles injected determines whether CPT code 20552 (1 or 2 muscles) or CPT code 20553 (3 or more muscles) is billed.  If one muscle is injected multiple times, it should be coded with the lower code 20552.

*This response is based on the best information available as of 9/16/24.

Fall Risk Prevention Program: Part 2

Question:

We read and received your recent Coding Coach on the Fall Risk Prevention Program and directive to report Category II CPT codes for this service. We have a follow-up question.  Why would we not be able to report CPT code 97750 for this service, and can this code be billed incident- to the physician if the MA performs the work?   

Answer:

Per CPT coding guidelines, many parameters are associated with reporting CPT code 97750. CPT code 97750 is not used for a MIPS tracking code. Reporting this code requires that the work be performed by an MD, DO, or PT. An MA may not perform the work associated with this code and bill incident - to, as an MA is not a Qualified Healthcare Professional (QHP). 

*This response is based on the best information available as of 9/16/24.

Choosing the correct code for Nerve Conduction Studies (NCS)

Question:

When coding for nerve conduction tests, how are sensory, motor with or without F-wave, and H-reflex studies counted for nerve conduction tests?

Answer:

Nerve conduction studies are performed by placing electrodes directly over the motor point of the specific muscle to be tested and/or electrodes placed over the specific sensory nerve to be tested. H-reflex studies involve both the motor and sensory nerves and assess their connections in the spinal cord.

For the purposes of coding, a single conduction study is defined as a sensory conduction test, a motor conduction test (with or without an F wave test), or an H-reflex test.

Each type of study (sensory, motor, H reflex) for each nerve includes all impulses associated with that nerve and is counted as a distinct study when determining the number of studies billed.

Each type of study is counted only once when multiple sites on the same nerve are stimulated and recorded. The number of tests (sensory, motor, H reflex) per nerve should be added to determine the code to be billed.

CPT Appendix J contains a listing of motor and sensory nerves with each nerve counting as 1 unit of service.

*This response is based on the best information available as of 9/16/24.

Polydactyly Excision

Question:

We have a new surgeon in our practice who does hand surgery. I usually don’t code for hand surgery and have never coded a case before for polydactyly excision; how does one code this procedure? The documentation does not reflect any bony work.

Answer:

Within the hand section of the CPT book, you will find CPT code 26587. This code is for the reconstruction of polydactylous digit, soft tissue, and bone. Below this, there is a parenthetical note that states that for excision of polydactylous digit, soft tissue, only use CPT 11200. The documentation within the note will lead you to the appropriate code to report. Based on your scenario presented, CPT 11200 is applicable.

*This response is based on the best information available as of 9/11/24.