Month: June 2018

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NPP Reporting and Claim Form Line 24J

June 28, 2018 Question: How do we know whether to put the NPP (PA or NP) or physician NPI number in box 24J on the claim form? Answer: When services are reported using the Direct billing method, the NPI of the provider performing the services places their NPI number in box 24J.  When services are...

Microscope with 63030 Issues
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Microscope with 63030 Issues

June 28, 2018 Question: Why do some insurance companies pay for the microscope (+69990) when we bill it for a lumbar discectomy (63030) and some don’t? I don’t get it. What recourse do we have if it isn’t paid?  Answer: First, CPT guidelines do not list 63030 as inclusive of the microscope so reporting 63030...

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Thoracic Nerve Blocks

June 28, 2018 Question: If I perform three separate injections at three intercostal levels can I report 64420 and 64421 x 2? Answer: No you should report 64421 (Injection, anesthetic agent; intercostal nerves, multiple, regional blocks). CPT code 64420 is used for a single injection and CPT 64421 is reported for multiple intercostal nerve blocks...

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Billing Visceral Angiograms

June 28, 2018 Question: Are visceral angiograms billed once, no matter how many visceral vessels are catheterized and imaged? Answer: No.  If more than one visceral vessel is selectively catheterized and imaged, code 75625 is reported for each vessel catheterized and imaged. Remember that an aortogram is included in any visceral angiogram.  However, each catheterization...

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Code Submission Order on Claims

June 28, 2018 Question: When we are submitting multiple procedures on a claim, should we submit the CPT codes in the order the procedures were performed, or the most serious findings first, or does it matter? Answer: You should submit codes in descending relative value unit (RVU) order.  If you don’t have software that gives...

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Excision with ATT

June 28, 2018 Question: My physician wants to code 14021 and 11606 for an excision and rotation flap to close an 18sq cm defect.  Is this correct? Answer: When adjacent tissue transfer or rearrangement is performed in conjunction with excision of a lesion, the lesion excision is not reported separately.  The only code you should...

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Complex Closure with a Soft Tissue Tumor Code

June 28, 2018 Question: Can I also bill for the complex repair when I’ve also excised a soft tissue tumor like a lipoma in the 21552-21555 series of codes? Answer: Actually CPT says these soft tissue tumor codes include the simple or intermediate repair and a complex repair may be separately reported.  That said, Medicare...

Debridement Prior to Skin Grafting
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Debridement Prior to Skin Grafting

June 14, 2018 Question: I’m taking a patient to the OR for debridement of a dehiscent surgical wound and will skin graft it for closure.  I’m looking at getting 11042 (debridement) and the skin graft codes precertified. Is this right? Answer: Not exactly.  You’re right about the skin graft code(s).  However, we do not recommend...

Reporting Bowel Left in Discontinuity
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Reporting Bowel Left in Discontinuity

June 14, 2018 Question: What codes are reported if the bowel is left in discontinuity as part of damage control surgery? Answer: Since the bowel is resected but an anastomosis is not performed, report the appropriate bowel resection code with a 52 modifier for reduced services. *This response is based on the best information available...

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