October 14, 2021 Question: I’m placing catheters in the erector spinae plane through a separate puncture after the surgical wound is closed. We are billing 64463 [Paravertebral block (PVB) (paraspinous block), thoracic; continuous infusion by catheter (includes imaging guidance, when performed] but it’s not always being paid. Please help. Answer: Actually, ensuring management of the...
September 30, 2021 Question: Do I use a modifier 58 (staged procedure) on the ventricular drain code when it’s done in the ICU after a craniotomy for tumor? Answer: That is probably not the correct modifier though we’d need more information about why the ventricular drain was placed. Typically, in this scenario, the ventricular drain...
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: Can we code separately for harvesting pericranial graft, such as temporalis fascia, when doing a craniotomy? Answer: CPT guidelines generally allow coding for harvest of graft material when it is obtained through a separate skin incision. In your scenario, the graft material is being obtained through the same surgical exposure and not via...
August 19, 2021 Question: Is there a code for turning off a VNS so the patient can have an MRI? The provider then turned it back on to the previously documented settings. Is this considered programming to use 95976 or 95977? Answer: There is not a code for turning off/on a VNS. However, if the...
August 5, 2021 Question: Is there a code for interpretation of an x-ray when placing percutaneous pedicle screws with use of C-arm fluoroscopy? Answer: No, this activity is included in the billed surgical CPT code. *This response is based on the best information available as of 8/5/21.
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...
