Painful Spinal Hardware

Question:

Our physician injected 0.5% Marcaine and 80 mg of Depo-Medrol to existing spinal hardware (eg, pedicle screws) at L4, L5, and S1 bilaterally for a patient complaining of painful hardware. Can CPT code 64483 be reported? 

Answer:

No. CPT code 64483, (Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level), represents transforaminal epidural nerve root injection performed in the lumbar region. There is no specific CPT code for the injection of spinal hardware. CPT code 64999, Unlisted procedure, nervous system, would be most appropriate to describe the injections for pain performed outside the foramen, as indicated in the clinical scenario provided in this inquiry. Although three spinal level (L4, L5, S1 bilaterally) injections were performed, code 64999 should be reported only once to represent the multiple injections. 

*This response is based on the best information available as of 5/9/24.

Soft Tissue Tumors

Question:

I excised a 1 cm lipoma from the patient’s scalp and reported CPT code 21011. I also performed an intermediate repair of 1.4cm and reported CPT 12031. I submitted the claim to the insurance company, and they denied the repair. Why can’t I get paid for the repair? Is the CPT code I submitted incorrect?

Answer:

When a soft tissue tumor excision is performed, the direct closure (simple or intermediate repair) is included in the soft tissue tumor excision and cannot be reported separately. According to CPT Assistant February 2010; a complex repair may be reported when extensive undermining or other techniques are used to close the defect and the elevation of tissue planes to permit resection of the tumor is included in the soft tissue tumor excision. Adjacent tissue transfer, split-thickness/full-thickness graft, muscle flap, etc. may also be reported separately. Keep in mind, though, that some payors may include the complex repair as payment for the soft tissue tumor excision.

Source: CPT Assistant February 2010

*This response is based on the best information available as of 5/9/24.

Cerumen Removal

Question:

Is the microscope considered “instrumentation” for 69210?  

Answer:

No. The microscope is for visualization, magnification, and/or illumination. It is not an instrument used to remove cerumen as required for 69210.  You must use and document an instrument such as suction, curette, right-angle hook, etc. to support using 69210.   

*This response is based on the best information available as of 5/9/24.

Medicare DMEPOS

Question:

Are DMEPOS covered by Medicare?

Answer:

The providers documentation needs to support the following key elements about the patient’s medical condition to substantiate the necessity of the type and quantity of items ordered, and for the frequency of use or replacement. The information should include the patient’s diagnosis and other pertinent information as applicable, such as 

• duration of the patient’s condition, 

• clinical course (worsening or improving), 

• prognosis, nature, and extent of functional limitation, 

• other therapeutic interventions and results, and 

• experience (past) with related items. 

*This response is based on the best information available as of 5/9/24.

Biopsy of Ear

Question:

What CPT code should I report for an excisional biopsy of the external ear?

Answer:

The correct code to use is 69100.

*This response is based on the best information available as of 4/25/24.

Post Operative Infection

Question:

What CPT code would I use for an I&D of a complicated postoperative wound infection?

Answer:

The correct CPT code is 10180 (Incision and drainage, complex postoperative wound infection).

*This response is based on the best information available as of 4/25/24.