A patient with hepatocellular carcinoma presents for chemoembolization. Through a microcatheter, a chemoembolic mixture of 50 milligrams of Adriamycin (Doxorubicin Hydrochloride) and 10 milliliters of Ethiodol (ethiodized oil) is infused manually into the right hepatic artery. Would it be appropriate to report both the chemotherapy and the embolization for the procedure performed?
Based upon the documentation submitted, it would be appropriate to report CPT code 37204, Transcatheter occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method, non-central nervous system, non-head or neck, for the chemoembolization of the hepatic artery. It would not be appropriate to separately report the administration of the chemotherapeutic drug since it is considered integral to the chemoembolization. In addition, report HCPCS code J9000, Doxorubicin HC1, 10 mg, for the drug administration of Adriamycin, and CPT code 75894, Transcatheter therapy, embolization, any method, radiological supervision and interpretation, for the radiological supervision and interpretation provided.
In the First Quarter 2007 issue of Coding Clinic for HCPCS, it was advised that if a splint is applied, it would be appropriate to report a CPT code for application of the splint regardless of whether the splint was off the shelf and/or prefabricated. I understand that items such as post-op shoes, slings, and ace bandages do not meet the criteria of a splint and are not separately reportable. How should the application of an air cast be reported? Does it meet the criteria for splint application or is this not a separately reportable service?
For hospital outpatient reporting, the application of the air cast would be inclusive in the code for the visit or procedure and would not be separately reported. The appropriate HCPCS level II code for the air cast can be reported when no restorative treatment or procedure (specific to that injury) is performed or expected to be performed.
An arthroscopic chondroplasty of the patellofemoral joint is being performed along with other knee procedures. A device (ArthroWand®) is being used for the chondroplasty. With the use of this device, radiofrequency ablation, also called cold or controlled ablation technique, is being performed instead of the usual routine debridement/shaving technique. Chondral debridement is still being performed using a lower level of heat on the affected tissue but without the use of the routine probe or motorized cutter/shaver. How should the chondroplasty of the patellofemoral joint be reported with the use of the ArthoWand® device? Can this procedure be considered as a routine debridement/ shaving (chondroplasty) although being performed using a different technique and device?
Report CPT code 29877, Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty), for the arthroscopic chondroplasty of the patellofemoral joint with an Arthro- Wand®. This code would be reported for the debridement or shaving chondroplasty procedure performed regardless of the device utilized.
A patient comes in for an endoscopic or surgical procedure but has a history of mitral valve prolapse or joint replacement so the doctor orders prophylactic antibiotics.
Can the medication infusion CPT codes 90765, Intravenous infusion, for therapy, prophylaxis, or diagnosis, (specify substance or drug); initial, up to 1 hour, and 90767, Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion, up to 1 hour (List separately in addition to code for primary procedure), be reported separately as it is specific to this patient and not part of the normal routine? Or is it included because this patient should or could not have the procedure done without the antibiotic infusion?
Although, the antibiotic infusion was specific to the patient and not part of the regular routine, the question remains whether or not the administration of the medication was due to the surgery. Therapeutic intravenous fluids, drug(s) or other substances administered that are integral to the procedure are not separately reported. Therefore, in this situation, the administration was prophylactic and would not be reported separately.
A patient presents to the emergency department. The physician ordered a bolus of fluid. After administration of the fluid, an antibiotic was ordered and infused for over 30 minutes. What is the correct way to report these services?
It would be appropriate to report CPT codes 90765, Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour, for the antibiotic administered. The bolus of fluid administered for hydration is not separately reported.
A patient presents to the emergency department. The physician orders a hydration rate of fluid for the patient which was administered for over 60 minutes. After administration of the fluid, an antibiotic was ordered and was infused for over 30 minutes. What is the correct way to report these services?
It would be appropriate to report CPT codes 90765, Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour, for the antibiotic administered, and 90761, Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure), for the hydration services.
Our facility is considering providing a new diagnostic service, computed tomography (CT) enteroclysis. This procedure involves the infusion of a barium-based contrast material through a nasojejunal tube and provides axial images of the small bowel when the small bowel is filled with contrast material.
We are having difficulty determining what code(s) should be reported for this procedure. How should the CT enteroclysis be reported?
Based on the documentation submitted, assign CPT code 76497, Unlisted computed tomography procedure (eg, diagnostic, interventional), for the CT enteroclysis performed. Report CPT code, 44500, Introduction of long gastrointestinal tube (eg, Miller-Abbott) (separate procedure), and CPT code 74340, Introduction of long gastrointestinal tube (eg, Miller-Abbott), including multiple fluoroscopies and films, radiological supervision and interpretation, for the tube placement and fluoroscopic guidance.
The CT enteroclysis performed in this report is not a traditional enteroclysis but a modified CT examination of the abdomen and pelvis.
A traditional enteroclysis performed for the examination of the small bowel utilizes a tube that is placed into the small intestine either through the nose or through the mouth with fluoroscopy utilized to guide and confirm the placement of the tube.
Additionally, the imaging associated with the placement of the tube using fluoroscopy would be reported. Please note, that fluoroscopic guidance is not reported separately when performed in a traditional enteroclysis.
It is recommended that the coder query the physician when colloquial terms such as “CT enteroclysis” is used instead of specific terms that describe the procedure more clearly (ie, CT of abomen and pelvis).
Additionally, the administration of intravenous contrast impacts the appropriate choice of CPT code, and this would need to clarified as well.