A patient with a right quadriceps tendon rupture with an extensive retinaculum tear underwent an open repair of the tendon rupture and the retinaculum tear. Our dilemma is that some of the coders feel that CPT code 27385, Suture of quadriceps or hamstring muscle rupture; primary, would be assigned since the four quadricep muscles in essence come down to form the quadriceps tendon. While other coders feel that CPT code 27385 would not be accurate and CPT code 27664, Repair extensor tendon, leg; primary, without graft, each tendon, would be more appropriate because the quadriceps tendon is an extensor tendon of the leg. The other perspective is that CPT code 27664 would not be appropriate for a quadriceps tendon repair because CPT code 27664 applies to leg (tibia and fibula) and ankle procedures since it is listed under the subsection in CPT [ie, Leg, (Tibia and Fibula) and Ankle Joint]. Yet a few of the coders feel that the unlisted code (27599) would be the most appropriate code assignment for the quadriceps tendon repair. What would be the correct code assignment for this case?
Based on the information provided in the operative report, only CPT code 27385, Suture of quadriceps or hamstring muscle rupture; primary, would be appropriately reported for this case. Although the code descriptor refers to the muscle, the muscle connects into a bone via a tendon, and the rupture was actually of the tendon and not the muscle. Therefore, code 27385 is the correct code assignment for this procedure.
What is the appropriate way to report the application of air casts in the outpatient hospital setting? Is there a difference between an air cast and an air splint? Is an air cast or air splint considered separate items that may be reported? Are custom made, fabricated, off-the-shelf, or pre-packaged (etc.) splints considered air casts or air splints?
The application of an air cast is not a separately reportable service. The work involved in the performing of a strapping technique is very different than the application of an off-the-shelf item such as an air cast or air splint. The supply of the air cast or splint may be reported with CPT code 99070 or a HCPCS Level II code, as appropriate. Please note this advice supercedes previously published advice.
In the 3rd Quarter 2009 issue of Coding Clinic for HCPCS, it was advised to report CPT codes 36558, Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older, and 99186, Hypothermia, total body, for CoolGard 3000, which is a device utilized to induce mild hypothermia. Besides the CoolGard system, our facility uses other methods to induce hypothermia without the use of central venous placement, such as direct intravenous infusion of cold saline. In CY 2010, CPT code 99186 was deleted and no replacement code was provided. Is there another code that can be recommended to capture the time and resources utilized by the facility to perform therapeutic hypothermia?
Report CPT code 37799, Unlisted procedure, vascular surgery, for the inducement of hypothermia utilizing the CoolGard 3000. Please note that the code assignment for the reporting of therapeutic hypothermia is dependent on the approach utilized (ie, IV infusion, cold saline). No code would be reported for the use of ice packs which would be captured in the evaluation and management (E/M) level service codes.
We use the Morgan Lens at our facility for eye irrigation and sometimes along with foreign body removal. What CPT/HCPCS codes should we report for this Morgan Lens Irrigation Procedure?
There is no specific CPT code for the Morgan Lens irrigation procedure. This procedure would be considered inherent to the Evaluation & Management service code for that encounter. Removal of a foreign body from the eye would be appropriately reported with CPT code 65205, Removal of foreign body, external eye; conjunctival superficial.
A patient with a neck injury was brought to our hospital emergency department. A cervical collar was placed by the emergency medical service (EMS) prior to the patient’s arrival to our facility. The emergency department physician ordered a one-view cervical spine x-ray (CPT 72020) to ensure the collar could be removed before a complete 4 view cervical x-ray (CPT 72050) was ordered and performed. There is a NCCI edit when CPT codes 72020 and 72050 are reported together. Can we report both codes in this scenario and append modifier 59 to bypass this edit or should we only report CPT code 72050 for the complete cervical x-ray?
Yes, both codes may be reported because they represent separate and distinct services. Report CPT codes 72020, Radiologic examination, spine, single view, specify level, and 72050 Radiologic examination, spine, cervical; minimum of 4 views, for the two separate cervical x-rays performed. It would be appropriate to append modifier 59, Distinct procedural service, to CPT code 72020 since the procedure had to be performed prior to removing the cervical collar in order to perform the complete cervical x-ray.
Patient presents to have an adjustable gastric band placed and repair of a hiatal hernia both performed laparoscopically. Additionally a laparoscopic core needle biopsy of the liver was performed. Our facility wants to know the appropriate CPT code assignment for the liver biopsy. Should CPT code 47379, Unlisted laparoscopic procedure, liver, be reported since it was performed with another laparoscopic surgical procedure? Or should CPT code 47001, Biopsy of liver, needle; when done for indicated purpose at time of other major procedure (List separately in addition to code for primary procedure), be assigned? Also, is code 47001 only for use when open procedures are being performed?
Yes, CPT code 47001, Biopsy of liver, needle; when done for indicated purpose at time of other major procedure, would be reported when the liver biopsy is performed during open procedure. Regarding this specific case, assign CPT code 47379, Unlisted laparoscopic procedure, liver, for the core needle biopsy of the liver performed laparoscopically. According to the operative report, trocars were placed in the right and left abdomen for laparoscopic access. Please note, when an unlisted CPT code is reported, it may be necessary to provide an operative report.
A 5-year-old patient presents to the emergency department with a fingertip avulsion amputation to the right ring finger. The injury is distal to the distal interphalangeal joint. The entire fingernail and nail matrix is contained within the amputated specimen. The third phalanx (P3) segment of bone has also been amputated. There is no chance for re-plantation of this fingertip. The decision was made to preserve the entire length of the finger. The amputated fingertip segment was de-fatted of all tissue down to the dermis which would be utilized for the full thickness skin graft over the wound. The emergency department staff placed the patient under conscious sedation. The P3 bone segment was trimmed and brought back to the level of the fingertip tissue. The prepared skin graft was applied to the finger wound and 5-0 interrupted chromic sutures were utilized to close the wound. How do we report the repair of the finger with the full thickness skin graft obtained from the amputated portion of the finger?
According to the documentation a fingertip avulsion amputation of the right finger was repaired with a full thickness skin graft over the wound. Because the procedure was performed on the finger of a child, CPT 15240, Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less, would be reported for the graft and repair of the injured finger.