Would an incision have to be made in order to report CPT codes 28190-28193 when coding emergency department visits on the facility side? For example: A patient presents with a nail shot through his foot by a nail gun. The nail is completely through the foot penetrating to the other side. The physician either cuts the nail or pulls it out and no incision is made and no suturing is necessary. How would this case be appropriately reported?
To report CPT codes 28190-28193, Introduction or Removal, an incision must be made to remove the foreign body. In the example provided, it would not be appropriate to report one of these codes for a nail that was pulled out from the foot since an incision was not made. This service should be considered inherent to the services provided during that encounter.
A patient presents as an outpatient for an endoscopic polypectomy. Anesthesia was administered and the colonoscopy was begun however because of poor colon preparation the colon could not be examined adequately and the procedure was aborted. What is the correct code assignment if the intended procedure was an endoscopic polypectomy? Would it be appropriate to append a modifier 74 to the procedure code?
Report CPT code 45383, Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s), not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique, with modifier 74, for the intended procedure which was not completed.
A patient underwent an aortoiliac and femoral angiogram in addition to a selective left renal angiogram at our facility.
Would it be appropriate to code fluoroscopic imaging with the angiography or transcatheter radiological supervision and interpretation codes?
Yes, it would be appropriate to report a code from range 75600-75989 (which includes fluoroscopy) to identify fluoroscopic supervision and interpretation used during an interventional or percutaneous vascular procedure.
Report CPT codes 75630, Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation, and 75722, Angiography, renal, unilateral, selective (including flush aortogram), radiological supervision and interpretation, for the fluoroscopic guidance performed.
Please note: There are codes for supervision and interpretation specific to angiography in CPT code ranges 75600-75989 and these codes include the use of fluoroscopy. Therefore, the fluoroscopy code would not be reported in addition to the angiography supervision and interpretation.
A 72-year old patient with severe multivessel coronary artery disease, status post redo coronary artery bypass surgery, is seen at our facility to undergo a left heart catheterization with right and left coronary angiography, left ventriculography, saphenous vein graft angiography, left internal mammary angiography, left subclavian angiography and right external iliac angiogram.
The problem arises when some of the physicians document “external iliac angiogram” while others do not.
Is it appropriate to report HCPCS code G0278 if the iliac angiogram is performed strictly to determine the type of closure?
No, it would not be appropriate to report HCPCS code G0278, Iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, injection of dye, production of permanent images, and radiologic supervision and interpretation, as an additional code to the appropriate CPT codes for the cardiac catheterization procedures performed.
The iliac angiogram was performed to assess the type of closure and is considered inherent to the procedure.
Based on the calendar year (CY) 2003 Medicare Physician Fee Schedule Final Rule (67 FR 80013), “the typical performance of these procedures involves the use of a pigtail catheter positioned in the aorta (not the renal or iliac artery(s), injection of a minimal dye load (because of the heavy dye load already used for cardiac angiography), and viewing the dye run off into the proximal main renal or iliac arteries under fluoroscopy.”
The performance of an iliac angiogram to assess the type of closure does not meet this criteria. In this case, the procedure was not performed due to disease-related or diagnostic issues, and was therefore inherent to the cardiac catheterization.
A patient presents for pre-admit screening prior to a gastrointestinal (GI) scope.
During the pre-admit process, the patient is found to have a past history of subacute bacterial endocarditis and is given pre-operative antibiotic prophylaxis. Intravenous (IV) pushes of Gentamycin and Ampicillin are given before the procedure. We are aware that pre-operative injections related to a procedure should not be reported.
In this instance however, the injection was not related to the procedure.
Would it be appropriate to report CPT code 90774 since the antibiotics are not given to every patient undergoing this procedure?
No, it would be inappropriate to report the intravenous (IV) pushes of antibiotics in this case. The patient received the IV antibiotics prophylactically due to the scheduled procedure; therefore, this would be related to the procedure and not considered a separate or distinct service.
Based on the National Correct Coding Initiative Policy Manual for Medicare Services it would only be appropriate to code separately for an injection or an infusion if it were provided for a reason unrelated to the procedure itself.
If the intravenous (IV) push of antibiotic was a distinct and separate injection unrelated to the procedure, it would be appropriate to report the intravenous pushes of Gentamycin and Ampicillin.
For example, if a patient has an active disease and is receiving intravenous antibiotics to treat the condition prior to a surgical procedure, the drug administration service would be considered separate and distinct from the procedure, and therefore separately reportable with modifier 59.
A patient received a full thickness debridement with opening of the bone cortex for a nonhealing diabetic foot ulcer. She is also scheduled to receive implantation of Apligraft following the debridement. There were 3 Apligrafts utilized.
If each Apligraft is 44 square centimeters and 3 were used, can we multiply 3 times 44 to determine the number of square centimeters reported for the J code?
Report HCPCS code J7340, Dermal and epidermal, (substitute) tissue of human origin, with or without bioengineered or processed elements, with metabolically active elements, per square centimeter.
Report the square centimeters of Apligraft actually used in the care of this patient for the number of units for this code.
What is the appropriate CPT code assignment for maggot therapy?
Report CPT code 97597, Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forcep(s), with or without topical application(s), wound assessment, and instruction(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area less than or equal to 20 square centimeters; and 97598, Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), with or without topical application(s), wound assessment, and instruction(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area greater than 20 square centimeters.
Maggot therapy, also referred to as biosurgical debridement, is considered a type of selective debridement that uses sterile maggots to clean wounds by dissolving the dead and infected tissue and also by killing bacteria.
A patient was seen at our facility to undergo a percutaneous (needle) computer tomography (CT) guided adrenal gland biopsy.
The CPT guidelines dictate an unlisted CPT code should be coded when there isn’t a specific CPT code for the procedure/service performed. Our encoder leads coders to CPT code 60699 but we are being told by some consultants to report CPT code 49180.
What would be an appropriate code assignment for this procedure?
Assign CPT code 60699, Unlisted procedure, endocrine system, for the CT-guided percutaneous (needle) biopsy of the adrenal gland. The adrenal glands are anterior to the kidneys and lie beneath the peritoneum. Report CPT code 76360, Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation, for the CT guidance.
Please note: Effective January 1, 2007, CPT code 76360 will be deleted and replaced with CPT code 77012, Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation.