Month: July 2018

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Thrombolysis Through a Chest Tube

July 26, 2018 Question: How is installation of tPA into a chest tube coded? Answer: Report this with the following codes:   CPT Code Description ⬤32561 Instillation(s), via chest tube/catheter, agent for fibrinolysis (eg, fibrinolytic agent for break up of multiloculated effusion); initial day ⬤32562 subsequent day   Each of these codes is reported once...

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Coding Embolization of a Dialysis Graft/Fistula – Part 2

July 26, 2018 Question: How many times can embolization of collateral vessels be reported at a single session?  The documentation supports embolizing several. Answer: Embolization of side branches in the dialysis circuit is coded with the add-on code +36909, Dialysis circuit permanent vascular embolization or occlusion (including main circuit or any accessory veins)), endovascular, including...

Facet Joint Injections without Guidance
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Facet Joint Injections without Guidance

July 26, 2018 Question: If I perform a facet joint injection of the Medical Branch (64490-64495) and don’t use guidance, can I still report these codes? Answer: No, according the many of the medical policies if guidance CT, US or Fluoroscopic is not used the service is reported as a trigger point injection (20552 or...

When is it OK to “Unbundle” 22845 from 22853?
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When is it OK to “Unbundle” 22845 from 22853?

July 26, 2018 Question: When is it acceptable to use modifier 59 on 22845 to unbundle it from 22853? Answer: To “unbundle” +22845 from +22853 and have it separately paid, you will report +22845 with modifier 59.  This is appropriate if you use a completely separate plate that spans the interspace, it can provide independent...

I&D of Abscess?
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I&D of Abscess?

July 26, 2018 Question: If one of our physicians uses a needle to puncture an abscess, but allows it to drain on its own and does not incise or aspirate anything into the syringe, can we bill 10060 for an incision and drainage of an abscess?  If not, could we use 10160 for puncture aspiration...

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Removal of Mandibular Implant

July 26, 2018 Question: We are removing old plates from the right and left mandible.  It is ok to use 20680 x 2? Answer: There was just a CPT Assistant about this in January 2018. CPT 20680 (Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)) may be reported...

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Multiple Fasciotomies Same Hand for Dupuytren’s

July 26, 2018 Question: Our hand surgeon, not infrequently, will perform multiple fasciotomies in the hand for the treatment of Dupuytren’s.  We are reporting CPT code 26045 for each fasciotomy but now we are questioning if this is correct or not.  Before we refund claims paid, will you tell us if this code is reportable...

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Discontinued Procedure

July 26, 2018 Question: I was excising a 2.5cm lipoma on the patient’s back in the office.  One the skin was opened I observed that there was a pulsatile mass from the vein.  I was concerned that this could be a large vascular structure so I discontinued the procedure to avoid potential massive bleeding?  Can...

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