June 16, 2022 Question: I almost always use a 12 French or larger catheter for placing the main body for EVAR. Do I always bill the new code 34713, when what I use is a 12 French or larger? Answer: Yes, if your approach/exposure is percutaneous. CPT code +34713, Percutaneous access and closure of femoral...
Category: Coding Coach
Knee Ligament Repair vs Reconstruction
June 16, 2022 Question: What type of graft or fixation material is required to report open extra-articular knee ligament reconstruction code 27427? Our physician is listing “MCL repair” and “MCL reconstruction” within the same operative note. It first describes repair of the ligament using Suture Tape. In a separate paragraph the physician describes insertion of...
Incident-to Requirements for Medicare
June 16, 2022 Question: Thank you so much for all the information you gave out in Chicago at the KZA Convention. We always have great take-a-ways when we leave there. I do have a question for you regarding incident-to billing for Medicare. One of my physicians is stating that her attorney told her being “under...
Billing for Intestinal Tear During Enterostomy Closure
June 16, 2022 Question: While performing a cholecystectomy a tear in the small bowel was made during extensive lysis of adhesions. Can repair of this injury be billed in addition to the cholecystectomy? It was unavoidable since it was the consequence of the extensive lysis required? Answer: Although the tear was unavoidable, the repair would...
Remote Patient Monitoring
June 2, 2022 Question: We are going to begin using remote therapeutic monitoring in our pain practice to monitor our patients pain functional status and compliance with exercise therapy. For the initial set up and education can our MA perform this service? Answer: Yes, the clinical staff may perform the initial set up, and education...
Bilateral Carpal Tunnel Procedures – Different Days
June 2, 2022 Question: We are going to be doing bilateral carpal tunnel procedures on a patient – the right side will be done first then the left will be done 8 weeks later. Should I use modifier 58 (staged procedure) on the 2nd procedure? Answer: Actually, it’s best to use modifier 79 (unrelated procedure...
Approved Telehealth Platforms
June 2, 2022 Question: Now that we aren’t limited to HIPAA compliant software, can we use any app or platform to conduct a telemedicine visit? Answer: During the public health emergency (PHE), you may use any app or platform that is not “public facing” according to HHS. Platforms such as Facebook Live, Twitch, and TikTok...
Fee Setting: Category III Codes or Unlisted Procedures
June 2, 2022 Question: We are looking at CPT code 0707T for reporting subchondroplasty in our practice. We have never billed a Category III code and do not know how to set the fee. Answer: Setting the fee for the Category III code will follow the same methodology as an unlisted procedure code. KZA recommends...
Coding for a Hospital Visit
June 2, 2022 Question: I was at your conference this past weekend and I was wondering if you could clarify something for me. When a physician sees a Medicare patient in the hospital, and it is their first time seeing the patient however they are NOT the admitting physician, they can only bill a subsequent...
CPT code 10080 versus 10081
June 2, 2022 Question: I am trying to code an I&D of a pilonidal cyst. CPT 10080 is simple and 10081 is complicated. How to do I know which code to choose? Answer: Great question, you would report CPT 10081 (complicated) if the procedure requires marsupialization, approximation of the wound’s edges, and/or primary closure. *This...