A patient with known ischemic cardiomyopathy was seen at our facility. He is status post coronary artery bypass (CABG) and a bi-ventricular implantable cardioverterdefibrillator. He was recently noted to have intermittently elevated impedance in his right ventricular (RV) lead. This has progressively elevated. He is now noted to have an impedance greater than 3,000 with an increase in thresholds and was scheduled for lead removal and a planned implantation of a new RV lead.
According to the procedural process the bi-ventricular defibrillator was explanted (removed) from the pocket. The atrial and left ventricular (LV) leads were both left attached to the defibrillator. The right ventricular (RV) lead was removed from the defibrillator and the proximal distal coil leads were left attached to the defibrillator. A pacemaker analyzer system was attached to the RV pacing lead. Testing of the RV pacing lead showed the lead was functioning properly. The lead was reinserted into the ICD and the ICD was placed back into the pocket. All of the remaining leads were tested showing no abnormalities. The pocket was irrigated with antibiotic solution and closed in layers. The defibrillator was reprogrammed. What would be an appropriate CPT code for the procedure performed?
Report CPT code 33999, Unlisted procedure, cardiac surgery, for the implantable cardioverterdefibrillator revision procedure performed. In addition, CPT code 93284, Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; multiple lead implantable cardioverterdefibrillator system, would be reported as an additional code for the programming. Please note, that CPT code 93284 is inclusive of the CPT code for insertion of a pacemaker but not of an unlisted code.
A patient presents to our facility with degenerative joint disease (DJD) of the sacroiliac joint. The patient is prepped for surgery and two screws were placed percutaneously into the sacroiliac(SI) joint. Since this procedure was not performed due to a fracture or dislocation, we feel that CPT code 27216 is not appropriate. However, we are unable to locate a CPT code for this service. What CPT code should we report for this encounter?
Currently, there is no specific CPT code for the placement of two screws into the sacroiliac joint for DJD. Based on the operative report, one screw was placed through the SI and into the S1 body, and one into the S1 ala on the right side. Therefore, because it appears that the procedure was performed in the pelvis, it would be appropriate to report CPT code 27299, Unlisted procedure, pelvis or hip joint. However, CPT code 22899, Unlisted procedure, spine, would be reported if performed in the sacroiliac joint. Additionally, please note that when reporting an unlisted procedure code, it may be required that supporting medical record documentation be submitted.
A patient with retrocalcaneal bursitis presents for excision of the bursa. How should this procedure be reported?
Currently, there is no specific code for excision of retrocalcaneal bursa. Therefore, it would be appropriate to report CPT code 28899, Unlisted procedure, foot or toes, for the procedure performed. When submitting an unlisted procedure code, it may be required that supporting medical record documentation is submitted.
The patient presents to the Wound Care Center for a bleeding left ankle eschar and venous ulceration. The ulceration was removed and the bleeding vein was avulsed. There was no mention of anesthesia being administered. The entire area was cauterized with silver nitrate and packing against the vein was done. What CPT code would be assigned for this procedure?
Based upon the documentation submitted, it appears that anesthesia was not administered. Assign 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 forceps) with or without topical application(s), wound assessment, and instructions(s) for ongoing care, may include use of a whirlpools, per session; total wound(s) surface area less than or equal to 20 square centimeters, or 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 instructions(s) for ongoing care, may include use of a whirlpools, per session; total wound(s) surface area greater than 20 square centimeters, depending upon the total square centimeters debrided. The cauterization performed is inclusive to CPT code 97597 and 97598. Please note, the size of the area that was treated is not mentioned in the operative note submitted. Please make sure that the size of the area that was treated can be verified in the patient medical record.
A 67 year old patient, status post panniculectomy, presents to our facility due to infected seroma of the right lower abdomen. The patient is taken to the operative suite where general anesthesia was provided. The seroma cavity was entered and cultures were obtained. The skin was incised along the entire length of the seroma (40 cm in length) and debridement was performed removing all of the granular tissue. The wall of the seroma was very thick and non-pliable and not amenable to re-closure. Therefore, a scalpel was used to resect the wall of the seroma back to healthy subcutaneous fatty tissue. Complex primary closure was performed of the abdominal wall totaling 40 cm in length. We are not sure if this procedure should be coded as a debridement or an excision. What are the appropriate CPT codes for this encounter?
Since the debridement did not produce the desired results, resection of the wall of the seroma was performed. 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 resection of the seroma. CPT code 13101, Repair, complex, trunk; each additional 5 cm or less, and seven units of 13102, Repair, complex, trunk; each additional 5 cm or less, would be reported for the complex closure totaling 40 cm.
The patient’s preoperative diagnosis was a far lateral herniated nucleus pulposus of the left L5-S1 area. According to the operative report exploration of the entire length of the nerve root and lateral and medial facetectomy was performed. However, once the procedure began, there was no compression of the nerve root, visibly no mass medially or laterally, and no extruded disc. The exploration proved to be negative and there was no far lateral disc herniation present; therefore, no disc was removed and the procedure ended. Some of our coders feel that because the procedure was started (although not completed) CPT code 63056, Transpedicular approach with decompression of spinal cord, equine and/or nerve root(s) (eg, herniated intervertebral disc), single segment; lumbar (including transfacet, or lateral extraforaminal approach) (eg. far lateral herniated intervertebral disc, should be reported. What are the appropriate CPT code assignments for this case?
Report CPT code 64999, Unlisted procedure, nervous system, for the procedure performed. Presently, there is no CPT code for a facetectomy performed alone. This was an exploratory procedure only, since no decompression nor was the removal of a disc done. According to the operative report, the exploration proved to be negative and there no extruded disc was seen.
The patient presented to the emergency department (ED) with bilateral ankle injuries. The right ankle revealed an open fracture of the lateral and posterior malleoli. The left ankle revealed no obvious sign of a fracture. Fracture reduction and splinting was performed. However, the ED physician was not satisfied with the end result of the treatment. The Orthopedic physician came to ED and felt that the patient needed surgical intervention. Therefore, the patient was taken to the operating room (OR) and another reduction was performed. Would it be appropriate to report both ankle reductions performed on the same day?
Assign CPT code 27810, Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); with manipulation, for treatment of the bimalleolar fracture which was performed in the emergency room. Report CPT code 27810 with modifier 77, Repeat Procedure by Another Physician, for the additional fracture treatment performed on the same day by a different physician. The appropriate evaluation and management (E/M) level of service code would also be report with modifier 25, Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service, appended.
A patient presents for a biopsy of the sternomanubrial joint via needle. The biopsy of the joint was performed via a 17/18 gauge biopsy system. No fluid was found within the joint. We are reporting CPT code 77012 for the CT guidance. What is the appropriate CPT code for the needle biopsy of the sternomanubrial/claviculomanubrial joint?
Since the biopsy was performed between the joints and not bone, assign CPT codes 20605, Arthrocentesis, aspiration and/or injection; intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa), and 77012, Computed tomography guidance for needle placement (eg, biopsy, aspiration injection, localization device), radiological supervision and interpretation, for the CT guidance.
Our facility would like clarification regarding the use of the term “subsequent” in the code descriptor of CPT code 49081, Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (diagnostic or therapeutic); subsequent. We have many patients with recurrent ascites that present to our facility for abdominal paracentesis every few months. Is CPT code 49081 intended to be used for any subsequent paracentesis regardless of the timeframe of the initial paracentesis? Or does the use of the term “subsequent” apply to any paracentesis performed after an initial paracentesis during the same encounter?
No. The use of term “subsequent” refers to a paracentesis performed on the same day encounter (short time frame). If the patient leaves the facility and comes back the next day, this would be considered an initial encounter.
Our facility would like clarification regarding the appropriate reporting of endoscopic submucosal inferior turbinectomy. Some of our coders feel that CPT code 30140 is appropriate since the code descriptor states “any method.” However, other coders feel that the use of the term “any method” in CPT code 30140 does not apply to the approach but rather to the method of turbinectomy, and therefore, CPT code 30140 would not be appropriate for endoscopic submucosal inferior turbinectomy. Please advise us on the correct CPT code for endoscopic submucosal inferior turbinectomy.
The code descriptor “any method” applies to both the approach and the inferior turbinectomy. Therefore, report CPT code 30140, Submucous resection inferior turbinate, partial or complete, any method, for the procedure performed.
A patient who presented earlier in the day for port removal presents due to retained portion of catheter in the right heart. Local anesthesia was given and the right internal jugular vein was cannulated. The catheter fragment was snared with a gooseneck and was removed in its entirety. Fluoroscopy confirmed complete retrieval of the fragment. What is the appropriate code assignment for the removal of the retained catheter fragment?
Report CPT code 37203, Transcatheter retrieval, percutaneous, of intravascular foreign body, (eg, fractured venous or arterial catheter), for the removal of retained catheter fragment. The fragment was located in the jugular vein and was removed percutaneously. CPT code 75961, Transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured venous or arterial catheter), radiological supervision and interpretation, for the fluoroscopic guidance performed.
A patient with osteoarthrosis presents for hip pain management. Under fluoroscopic guidance, the site for intra-articular injection was marked. The skin was prepped and draped and local anesthesia was then provided. Under fluoroscopic guidance, a 22 gauge needle was advanced into the right hip joint cavity. The needle was confirmed with Isovue. Subsequently, 1 mL of Depo-Medrol and 4 mL of bupivacaine were injected into the joint cavity. What are the appropriate codes for the hip arthrogram with injection of pain medication?
Report CPT code 20610, Arthrocentesis, aspiration and/or injection: major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa), for the injection of pain medication into the hip joint. CPT code 77002, Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), should be reported in addition to CPT 20610 for the fluoroscopic guidance used.
A patient with squamous cell carcinoma in two locations of the left ear was brought to our outpatient facility to undergo an excision of the adjacent lesions. The excision involved skin and subcutaneous tissue in addition to cartilage. A complex repair of the upper pole of the ear and closure with advancement of the retroauricular skin flap was performed. What is/are the appropriate procedure code assignment(s) for this case?
Report CPT code 14061, Adjacent tissue transfer or arrangement, eyelids, nose, ears and/or lips; defect 10.1 sq. cm to 30.0 sq cm, for the excision of the squamous cell carcinoma of the left ear and closure with an advancement flap. CPT code 69110, Excision external ear; partial, simple repair, would be inappropriate for this case because according to the operative report the entire earlobe was excised and an advancement flap was performed.
A patient with a diagnosis of chronic obstructive pulmonary disease (COPD) was seen at our facility and deemed a candidate for fast track transtracheal oxygen catheter placement. Our coders assigned CPT code 60200, Excision of cyst or adenoma of thyroid, or transaction of isthmus, and CPT code 31730, Transtracheal (percutaneous) introduction of needle wire dilator/stent or indwelling tube for oxygen therapy, for the procedures performed. Is it appropriate to report CPT code 60200 in addition to CPT code 31730 to fully describe the “Fast Tract” technique?
Report CPT code 31730, Transtracheal (percutaneous) introduction of needle wire dilator/stent or indwelling tube for oxygen therapy, for the procedures performed. The excision of the fat pad, division of the thyroid isthmus, and the tracheostomy tube inserted, would be considered inherent to CPT code 31730, and therefore would not be reported separately.
A patient who underwent an ankle fusion previously was seen at our facility with areas of localized tenderness of the medial ankle. Work-up revealed a prominent screw head as the cause of the localized tenderness. A decision was made to remove the screw and exchange it with a shorter screw. What are the appropriate code assignments for this scenario?
Presently, there is no CPT code for exchange of hardware. Therefore, report CPT code 20680, Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate, for removal of the screw from the medial ankle. CPT code 27899, Unlisted procedure, leg or ankle, would be reported for the insertion of the shorter screw.