September 16, 2021 Question: A patient with multiple sclerosis came into our pain clinic with spasms to the left and right upper arms. The physician injected the following muscles using EMG guidance; Right upper limb; right biceps, pronator teres, brachioradialis, first dorsal interosseous, and extensor carpi ulnaris and left upper limb, right biceps and brachioradialis....
September 16, 2021 Question: We billed 15260 (full thickness graft, ear) and 13132 (complex repair, ear) and were not paid for the complex repair. Can you help us with an appeal? Answer: Suturing the full thickness graft into place is not separately coded with a complex repair or any other code. Affixing the full thickness...
September 16, 2021 Question: When are diagnostic angiograms and an intervention (angioplasty, stent, etc.) both billable? Answer: Diagnostic angiograms are separately billable during an intervention if no adequate or prior adequate angiogram exists. Code diagnostic angiograms only if: no previous angiogram is available, the prior angiogram is not adequate to diagnose the disease, or the...
September 16, 2021 Question: Our pain management physician stated he performed a trigger point injection into 1 muscle. In reviewing the procedure note we find that the documentation supports dry needling was performed. Is CPT code 20552 (Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)) the correct code? Answer: No, you would not...
September 16, 2021 Question: One of our doctors saw a patient and billed 31231 (nasal endoscopy). The doctor did not document that a topical vasoconstrictive agent was applied. Does the topical anesthesia need to be applied to bill 31231? If topical anesthesia is required and was not used, would modifier 52 (reduced services) need to...
September 16, 2021 Question: We have recently begun treating our psoriasis patients using XTRAC laser therapy. I have looked extensively and cannot find a CPT code for this procedure. Can you help me? Answer: The XTRAC excimer laser is reimbursed by most payors for mild to moderate plaque psoriasis by most major insurance carriers. Some...
September 16, 2021 Question: If a code does not specify whether the procedure described is laparoscopic or open, is it acceptable to use it if the procedure was performed laparoscopically? Answer: No. Laparoscopic codes will always have the term “laparoscopic” in the code description. If there is no laparoscopic code for a procedure you performed...
September 16, 2021 Question: If a patient has one stable chronic illness and one acute uncomplicated illness without systemic symptoms, can we “up” the level of Problems Addressed to Moderate? Answer: No, sorry, unfortunately it doesn’t work that way. The problems are not additive or cumulative. One stable chronic illness and one acute uncomplicated illness...
September 2, 2021 Question: My doctor did a regional thoracic nerve block. He performed three injections at three intercostals levels. How do I code that? Answer: You would report 64420 (Injection, agent (s) and /or steroid, intercostal nerve, single level) and 64421 x 2 for the two additional level. Each additional level is reported with...
September 2, 2021 Question: I heard that a medical assistant who enters the patient’s medications into the electronic health record must be certified. Is this true? Answer: Actually, Medicare requires the MA to be certified to perform order entry. They do not have to be certified to enter patient information such as vital signs or...
