Date of Service

Question:

We are in an academic setting. Our residents will see a patient, for example, at 11 pm on Tuesday.  Wednesday morning, our attending physician evaluates the patient, documents his/her findings, documents the required attestation, and enters an E&M into the EHR. The date of service is the date the encounter was created by the resident on Tuesday.   Do you bill the E&M with the Tuesday date of service or the Wednesday date when the attending physician saw the patient?  

Answer:

The correct date of service is the actual date of service when the attending physician saw the patient.  In this case, it will be Wednesday even if the attending physician links the note to the resident note from the previous date.  

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

Piriformis Muscle Injection

Question:

We perform Piriformis muscle injections in the office under ultrasound guidance, what code should we be reporting for this service? 

Answer:

The correct code(s) that should be reported for the service are 20552 for the piriformis muscle injection and 76942 for the ultrasound guidance. 

Rationale: Per CPT Assistant April 2012  

There is a significant difference in the work and procedure, as well as intent, between an injection of the piriformis muscle and the perineural injection of the sciatic nerve. The sciatic nerve injection code (64445) should not be used to report a piriformis injection. Piriformis muscle injection(s) should be reported using CPT code 20552, Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s). 

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

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.