Non-Selective vs Selective Catheterization

Question:

What is the difference between non-selective and selective catheterization?

Answer:

Non-selective catheterization is when the catheter remains in the accessed vessel site (puncture site) and is not navigated further into other vessels. Selective catheterization is when the catheter is manipulated out of the access vessel, or out of the aorta, to additional vessels.

*This response is based on the best information available as of 2/27/25.

Bone Marrow Harvest for Ankle Arthrodesis

Question:

Our surgeon harvested bone from the calcaneus (same incision) and also harvested bone marrow from the iliac crest for an ankle arthrodesis. We know the bone graft from the calcaneus is not reportable. Is the bone marrow aspirate reportable? If yes, what CPT code do you recommend?

Answer:

You are correct that bone graft harvested via the same incision is not separately reportable. CPT instructs to report 20999 for the bone marrow harvest when performed for an arthrodesis in musculoskeletal system, excluding spine.

Based on your inquiry the correct code for the ankle arthrodesis is 27870 (Arthrodesis, ankle, open). Your reportable codes are 27870 and 20999.

Note, there are no NCCI edits between 27870 and 20999. Consider adding modifier 59 if necessary to indicate the bone marrow aspirate was from a different location, separate incision.

KZA recommends using 20939 as the comparison code for 20999.

*This response is based on the best information available as of 2/27/25.

A Follow-up Question on Scar Revision

Question:

I reviewed your updated coding coach on scar revision and have a follow-up question. What if the scar was revised with an adjacent tissue transfer (ATT)?

Answer:

Thank you for your follow-up question!

Providing the requirements for reporting an adjacent tissue transfer (ATT) have been met and the adjacent tissue transfer is documented appropriately the ATT can be reported.

The CPT guidelines for adjacent tissue say that the term defect includes primary and secondary defects; the primary defect results from the excision, and the secondary defect results from the flap design.

The primary and secondary defects should each be documented separately in centimeters (cm); both measurements are added together to arrive at the total sq cm, allowing for appropriate code.

*This response is based on the best information available as of 2/27/25.

Interspace Between the Popliteal Artery and Capsule of the Posterior Knee (iPACK) Block

Question:

KZA, thank you for the information on the Coding Coach on the PENG block.  Do the same CPT codes apply to an interspace between the Popliteal Artery and Capsule of the posterior Knee (iPACK) block?

Answer:

While the Pericapsular Nerve Group (PENG) targets the anterior capsule of the hip, the iPACK block focuses on the posterior knee joint.

The creation of CPT codes 64466 – 64474 describes blocks performed in the fascial plane and distinguishes the fascial plane blocks from a nerve block.

CPT codes 64473 and 64474 are used for the infiltration of the interspace between the Popliteal Artery and the capsule (iPACK) block. The applicable code will depend on whether an injection or continuous infusion is performed.

• 64473 – Lower extremity fascial plane block, unilateral; by injection(s), including imaging guidance, when performed

• 64474 – Lower extremity fascial plane block, unilateral; by continuous infusion(s), including imaging guidance, when performed

*This response is based on the best information available as of 2/27/25.

7th Character for Cast Re-application

Question:

We are a bit confused about what 7th character code we should use when the patient is being seen in follow-up for a fracture. The initial encounter was reported with the “7th character” for the initial evaluation and application of cast or splint. When the patient returns and the surgeon re-applies a new cast, do we use the 7th character code for active treatment or the 7th character code for routine healing?

Answer:

Thank you for your inquiry. You are not alone in your confusion even 8 years after ICD 10 was implemented. You are correct to use the “initial treatment” (sometimes referred to as the active treatment) code for the initial evaluation of the patient. If the treatment plan is to apply a cast, and the patient returns, they are stable, healing has begun, the correct 7th character code for the fracture will be the “routine healing or follow-up care.”

Other examples of when you might use the 7th character for routine healing/subsequent encounter, in addition to the cast/splint re-application, are:

· Dressing change or removal

· Staple or suture removal

· Removal of external or internal fixation device

Some of the confusion stems from references to “initial” treatment and “active” treatment.

ICD identifies the 7th character, based on the location and type of fracture, to be:

• Initial

• Routine

• Delayed

• Nonunion

• Malunion

*This response is based on the best information available as of 2/13/25.

Reporting An Unlisted CPT Code

Question:

What is needed to report an unlisted CPT code?

Answer:

To report an unlisted CPT code, you must first make certain that no code exists that represents the procedure in its entirety or with a modifier that would represent what was performed (e.g., modifier 52 for reduced services). Once it is determined that there is no existing code to represent the work, choose a code from the appropriate anatomical section of CPT, the appropriate approach (i.e. open vs laparoscopic), and compare the unlisted code to another code that most closely resembles the anatomical area, approach (if possible) and work involved to accurately compare RVUs and reimbursement expectations.

*This response is based on the best information available as of 2/13/25.