We are a cyberknife center and need clarification regarding how to correctly assign CPT code 77300. We have been informed by our physicist that each stereotactic beam differs from the next beam with regards to the depth and dose delivered by each beam. We also were informed that the beams are reviewed, verified and approved from the computer generated treatment plan. Based on the following example, how many times should code 77300 be assigned? Is the code assignment based on paths or beams? If code 77300 is incorrect, what is the correct code for the example?
Example for a cyberknife treatment of one brain tumor
1Path total MU: 2371.302
Total beams: 124
Total non-zero beams: 115
Total imaging beams: 91
Total zero dose beams: 9
The treatment was performed on one brain tumor with one path, therefore one field. Report CPT code 77300, Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of nonionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician, for the number of areas or fields treated-not the number of beams.
Are HCPCS Level II codes specific to a single trade name product or would the HCPCS code apply to any other product within the HCPCS code descriptor? We have received several inquiries regarding the correct reporting of HCPCS Level II codes, specifically HCPCS code A9560, Technetium Tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries.
No, HCPCS code A9560, Technetium Tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries, is not trade name specific.
HCPCS Level II codes are generally not trade name specific but on rare occasions the Centers for Medicare & Medicaid Services (CMS) HCPCS workgroup may determine the necessity of a HCPCS code to be product specific.
However, when this happens, it is made clear by including the trade name or product details in the code descriptor to identify what that product or specifications are in the code descriptor itself.
Would it be appropriate to append modifier 52 (Reduced Services) to CPT code 97803 (Medical Nutrition Therapy Reassessment) if the time spent with the patient was only 10 minutes?
In addition, if the reassessment time spent with the patient was 25 minutes, would it be appropriate to report 2 units of CPT code 97803? How would these scenarios be appropriately reported?
CPT code 97803, Medical nutrition therapy; re-assessment and intervention, individual, face to face with the patient, each 15 minutes, would be reported for each increment of 15 minutes. One unit, or additional unit, of CPT code 97803 should be reported when 8- 22 minutes of therapy is provided initially or following the prior fifteen minute period.
Therefore, report 2 units of CPT code 97803, for the 25 minutes of reassessment and intervention services provided. Report 1 unit of CPT code 97803, for the 10 minutes of reassessment and intervention services provided.
According to the coding instructions provided in the CPT code book, codes 90281-90399 identify the immune globulin product only and would be reported in addition to the administration codes 90765- 90768, 90772 and 90774 as appropriate.
However, there are specific HCPCS Level II codes that also identify the immune globulin product: HCPCS codes J1571, Injection, hepatitis B immune globulin (Hepagam B), intramuscular, 0.5 ml, and J1573, Injection, hepatitis B immune globulin (Hepagam B), intravenous, 0.5 ml.
If a patient was receiving an HBIG injection other than Hepa Gam, would this be appropriately reported with two codes 90371, Hepatitis B immune globulin (HBIg), human, for intramuscular use, and 90772, Therapeutic, prophylactic or diagnostic injection; subcutaneous or intramuscular, OR with three codes, 90371, Hepatitis B immune globulin (HBIg), human, for intramuscular use, 90772, Therapeutic, prophylactic or diagnostic injection; subcutaneous or intramuscular, and J1571, Injection, hepatitis B immune globulin (Hepagam B), intramuscular, 0.5 ml.?
Two codes should be reported to identify the HBIG product that is other than HepaGam and administered intramuscularly.
Only one HBIG product, Hepa- Gam B, has been approved by the Food and Drug Administration (FDA) for intravenous administration. There are two trade name specific HCPCS codes that can be appropriately reported for Hepa- Gam B: HCPCS code J1571, Injection, hepatitis B immune globulin (Hepagam B), intramuscular, 0.5 ml, and HCPCS code J1573, Injection, hepatitis B immune globulin (Hepagam B), intravenous, 0.5 ml.
Therefore, if the product administered is trade name HepaGam, the appropriate HCPCS J code (J1571 or J1573) would be reported. If other HBIG product is administered, the appropriate CPT code would be reported. Please note that only one code (i.e., CPT or HCPCS Level II) should be reported for the product.
The code descriptor for HCPCS code C8957, Intravenous infusion for therapy/diagnosis; initiation of prolonged infusion (more than eight hours), requiring use of portable or implantable pump, specifically states infusion for “therapy/ diagnosis.”
If a patient is given more than 8 hours of hydration via a portable or implantable pump, is it appropriate to report HCPCS code C8957?
Is hydration considered a type of infusion for therapy/diagnosis? If not, how should 8 or more hours of hydration via a pump be reported?
It would be inappropriate to report HCPCS code C8957, Intravenous infusion for therapy/diagnosis; initiation of prolonged infusion (more than eight hours), requiring use of portable or implantable pump, for the administration of hydration.
Hydration services are appropriately reported with CPT code 90760, Intravenous infusion, hydration; initial, 31 minutes to 1 hour, and CPT code 90761, Intravenous infusion, hydration; each additional hour, even if administered via a pump.
A right peroneal tenosynovectomy was performed for treatment of subluxation of the right peroneal tendon. During the operative episode an anomalous muscle of the peroneal tendon was identified. Because the anomalous muscle was separate in itself the muscle was excised in its entirety.
Would it be appropriate to code both the tenosynovectomy and the excision of anomalous muscle?
Report CPT code 27626, Arthrotomy, with synovectomy, ankle; including tenosynovectomy, for the peroneal tenosynovectomy with excision of the anomalous muscle for the right peroneal tendon sheath. The excision of the anomalous muscle of the right tendon sheath would be considered inherent in the CPT code for tenosynovectomy.
A patient status post bilateral mastectomies develops necrotic skin edges of the mastectomy flap sites on both breasts. She presents for excision of the necrotic skin edges.
After the administration of general anesthesia, the surgeon documents that he made a 9.5 cm length excision of the necrotic skin on the right breast and a 27 cm length excision of the necrotic skin on the left breast. Complex closure is performed on both breasts totaling 36.5 cm in length.
We are not sure if this procedure should be reported as an excision or as a debridement. We queried the physician for clarification and he stated that the procedure performed was not a debridement.
However, we are not sure if it is appropriate to consider necrotic skin a “benign lesion” and report a code from category 11400. What are the appropriate CPT codes for this encounter?
Based upon the documentation and the physician clarification obtained, it appears that an excision was performed on both breasts totaling 36.5 cm in length.
Therefore, it would be appropriate to report CPT code 11406, Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm, for the procedure performed. CPT codes 13101, Repair, complex, trunk; 2.6 cm to 7.5 cm, and 6 units of 13102, Repair, complex, trunk; each additional 5 cm or less, should be reported for the complex closure totaling 36.5 cm in length.
A patient with osteomyelitis of the second metatarsal of the left foot and diabetes mellitus presents for debridement of the osteomyelitis.
Following debridement of the osteomyelitis, application of platelet aggregation system is performed. The surgeon performs the second half of the procedure by fabricating the platelet aggregation system and placing it inside the wound.
How should we report application of platelet aggregation system?
It would be inappropriate to report a CPT code for the platelet aggregation performed. This would be considered part of the procedure and no additional code would be assigned.
Patients at our facility sometimes present for ligation of their arteriovenous (AV) fistula due to poor maturation of the fistula. This procedure is commonly performed as the only procedure other than a fistulogram. We have been reporting this procedure with CPT code 37799.
Is there a more specific CPT code available for this procedure?
Report CPT code 37607, Ligation or banding of angioaccess arteriovenous fistula, for ligation of the AV fistula. In addition, would be appropriate to separately report the fistulogram, if a fistulogram was performed.