Month: October 2017

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“Stacked” DIEP

October 19, 2017 Question: What is the code for a “stacked” DIEP flap used for breast reconstruction? Answer: CPT says 19364 is used for a free flap breast reconstruction of any type.  There is not a separate CPT code for a “stacked” DIEP flap reconstruction.  Some payors will allow the HCPCS II code S2067; however,...

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Coding Facet/Medial Branch Block Injections

October 19, 2017 Question: I heard that regardless of the number of facet injection performed on a single side, only three levels may be reported. Is this a payor rule? Answer: CPT guidelines state that the facet injection add-on code, for example, code +64495 for the third level, lumbar or sacral, includes the third and...

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Thrombolysis and Catheterization

October 19, 2017 Question: If a thrombolysis infusion catheter is placed, can the catheterization (for example 36247) be billed in addition to the thrombolysis (37211)? Answer: Yes, the catheterization, (36245-36247) may be separately reported in addition to the thrombolysis code (37211).  Remember, if a diagnostic angiogram is also performed, this may also be separately reported....

Assistant Surgeon Payments
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Assistant Surgeon Payments

October 19, 2017 Question: We are seeing payers ask for payment back when we use Modifier 80 for assistant surgeon. Is there a reason why they would take the payment back? Answer: Without additional information it is difficult to respond to your inquiry.  First, Medicare has a list of surgical CPT codes where payment will...

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Esophagoscopy and Glossectomy

October 19, 2017 Question: Can I bill 43191 for the rigid esophagoscopy (or 43200 for a flexible esophagoscopy) performed at the same operative session as the glossectomy (eg, 41150)? I do this to map out the tumor for removal and make sure there are no other tumors that may have occurred since I saw the...

Lumbar Stenosis Diagnosis Code
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Lumbar Stenosis Diagnosis Code

October 19, 2017 Question: I just received a claim denial because I used M48.06 (Spinal stenosis, lumbar region) as the diagnosis code. What’s the deal? I’ve been using this diagnosis code without a problem since ICD-10-CM started. Answer: Aha!  There are new diagnosis codes for lumbar stenosis that were effective October 1, 2017.  The code...

EMG Guidance with Extremity Chemodenervation
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EMG Guidance with Extremity Chemodenervation

October 5, 2017 Question: How many times can code 95874, Needle electromyography for guidance in conjunction with chemodenervation, be reported If chemodenervation is performed on four extremities (e.g., 64642, 64643, 64644, 64645)? Answer: Per CPT, code 95874 is reported for each corresponding chemodenervation of the extremity.  In the example, four chemodenervation codes were reported, therefore,...

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