Genicular Nerve Injection

Question:

What is the correct code (s) to report when the physician injects the superomedial and superolateral branches of the genicular nerve for knee pain with a steroid?

Answer:

The correct code to report for this service is 64454 (Injection (s), anesthetic agent (s) and/or steroid; genicular nerve branches including imaging guidance, when performed) with modifier 52 (Reduced Services). If all 3 nerve branches of the genicular nerve (superolateral, superomedial, and inferomedial) are not injected the service is reported with modifier 52. CPT code 64454 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 4/11/24.

Stent vs. Embolization or Both

Question:

If the surgeon uses a covered stent and performs an embolization on a patient with a pseudoaneurysm, can we bill for both the stent and removal of the embolus?  

Answer:

If a covered stent is deployed as the sole management of an aneurysm, pseudoaneurysm or vascular extravasation, then the stent deployment should be reported and not the embolization code.

*This response is based on the best information available as of 4/11/24.

Post Operative Infection

Question:

What CPT code would I use for an I&D of a complicated postoperative wound infection?

Answer:

The correct CPT code is 10180 (Incision and drainage, complex postoperative wound infection).

*This response is based on the best information available as of 4/11/24.

Breast Biopsies on Both Breasts – Same Session

Question:

Our breast surgeon performed biopsies (with a clip) on both the right and left breasts using ultrasound imaging. Do we code 19083 x 2 units since they are different breasts, or would we use 19083 and 19084 as the add-on code?

Answer:

If additional lesions (as you have described above) are biopsied in the contralateral breast using the same imaging, report the primary code and the add-on code for the second lesion. If more than one lesion is biopsied, using different imaging modalities, report the appropriate primary code for each.

*This response is based on the best information available as of 4/11/24.

Billing an Extremity Angiogram with a Neuroendovascular Procedure

Question:

Our endovascular surgeons image the radial artery at the beginning of the procedure ( an initial run) to ensure that the artery is healthy/ in good shape to move forward with the procedure. They do not begin the actual procedure without ensuring the radial artery is normal. They also perform imaging as they complete the procedure (on the way out) to assess for any damage to the artery. Is this separately billable as 75710, imaging of a peripheral artery?

Answer:

Imaging of the access artery (radial or femoral) whether to assess patency of the access artery or as a completion study, checking to make sure no damage has been done to the access vessels is never billed separately.   Accessing a vessel is the approach for an endovascular procedures and is included in the primary procedure.  Furthermore, although not the primary reason for not billing, there is no pathology to support the medical necessity of  an extremity angiogram and that code requires imaging and documentation  of a full extremity study;  the entire arm,  not just a single peripheral vessel. 

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

Biopsy of Eyelid

Question:

Can I use CPT code 11106 for an incisional biopsy of the eyelid? 

Answer:

An incisional biopsy of the eyelid is not reported with CPT code 11106 but is reported with CPT code 67810 (biopsy of the eyelid).

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