July 22, 2021 Question: My surgeon did an ACDF at C5-C6 and C6-C7 but also did an artificial disc (TDA) at C4-C5. Can I bill for all three procedures? Answer: Yes, you may bill for different procedures performed at different spinal levels. You may need to append modifier 59 (distinct procedural services) to reflect the...
July 8, 2021 Question: The provider listed one of the procedure statements as bilateral percutaneous L4-L5 segmental instrumentation placement along with the fusion and decompression procedures. In the body of the note he describes placing instrumentation on both sides for the L4-L5. We queried the provider asking for correction of listed procedure to non-segmental (22840). ...
June 24, 2021 Question: The neurosurgeon performed an ACDF and then also did a carpal tunnel decompression at the same time. When we were paid by insurance, they paid us half of the allowable for the carpal tunnel procedure code. Is that correct? Should we have billed the carpal tunnel Surgery (64721) with modifier 59...
June 10, 2021 Question: What is the correct ICD-10-CM for bilateral sciatica? My doctor tells me to use both M54.31 & M54.32 but this doesn’t seem right. Answer: There is not a diagnosis code for bilateral sciatica. You are correct to use M54.32 and M54.31 to report this condition. *This response is based on the...
May 27, 2021 Question: When doing a T12 & L3 kyphoplasty, are the correct codes 22513 (thoracic) and 22514 (lumbar)? Answer: The correct codes are 22513 (thoracic) and +22515 (additional level) for your example. It is not accurate to report two stand-alone codes (22513 and 22514) for procedures performed at the same operative session. *This...
May 13, 2021 Question: We are new to neuroendovascular coding. How do I know what’s a 2nd order or 3rd order vessel? This is very confusing to me. Answer: Agree it is confusing! Consult Appendix L in your CPT book for more information. Additionally, Kim and Teri are available to provide a neuroendovascular coding course...
April 29, 2021 Question: I just finished my residency and am in an employed situation. In reviewing my end-of-month RVU reports, I’m seeing a lot of the codes I submitted are missing. I’m starting to wonder if I have been coding wrong or the hospital’s coders. Can we code for intrathecal morphine at the end...
April 15, 2021 Question: I’m still confused about the new E/M guidelines. Do these new guidelines apply to the consultation codes? Also, I have so many more questions, can you help me? Answer: Yes and yes! First, the new E/M guidelines do NOT apply to the office/outpatient consultation codes, 9924x. So you’ll continue to code...
April 1, 2021 Question: Under the new E/M coding revisions for office visits, should we document time AND medical decision making for every visit? Answer: According to advice from the AMA (3/24/21 webinar), you should only document one or the other to prevent potential audit confusion and risk. Document time if billing by time OR...
March 18, 2021 Question: Can I bill a wound debridement code such as 11043 when I debride an infected wound and take out a VNS battery? Answer: Don’t forget that the debridement codes, such as 11043, are for debriding open wounds that will stay open and heal by second intention. That’s not what you did....
