May 11, 2023 Question: Can we bill for a simple repair when the surgeon performs Mohs? Answer: An intermediate or complex repair, flaps or grafts may be reported in addition to MMS. The simple repair is included in the procedure and is NOT reported. *This response is based on the best information available as of...
May 11, 2023 Question: I placed a non-biological implant for abdominal soft tissue reinforcement. Can this be coded as +15777? Answer: No. Code +15777 is reported specifically for a biological implant for soft tissue reinforcement implant in breast or trunk only. Code +0437T, a Category III code, is reported for implantation of a nonbiologic or...
May 11, 2023 Question: The surgeon placed methylmethacrylate around the pedicle screw in a spine surgery. How is this coded? Answer: Placing methylmethacrylate to reinforce the instrumentation is included in the spine procedure. *This response is based on the best information available as of 05/11/23.
April 27, 2023 Question: When choosing the level of E/M we are confused about the History and Exam. If we choose a level of E/M based on time, does this time count toward total time, or is it only time spent on MDM? Answer: When choosing a level of E/M based on time, CPT identifies...
April 27, 2023 Question: A patient with a clot in the femoral artery had overnight infusion of thrombolytics. When the catheter was removed the next day, the doctor place a stent in the same artery, the superficial femoral . can both be billed? Answer: Yes, the removal of the catheter, 37214 is billed in addition...
April 27, 2023 Question: I have a question regarding 2023 shared visit rules. I am reviewing an E&M note where I will select the level of E&M based on the MDM being the substantive part and not time. My question: does each provider have to document their individual time if not a factor in the...
April 27, 2023 Question: We routinely bill allergy an E/M service when the patient comes in for allergy shots. Is that acceptable? Sometimes we bill 99211 if the nurse gives the injection and sometimes if the PA gives the injection 99212. Answer: E/M visits should not be reported with allergy injection services 95115 or 95117...
April 27, 2023 Question: If a patient undergoes an open cholecystectomy and has a reducible umbilical hernia repaired during the same operative session, through separate incisions, can both be reported? Answer: Yes, if both procedures were performed through separate incisions both may be reported. Conversely, if both were repaired through the same incision, only the...
April 27, 2023 Question: When using LITT treatment, can the neuronavigation and headframe placement be billed separately? Answer: No, neuronavigation, 61781 and headframe placement, 20660 are included and may not be billed separately. *This response is based on the best information available as of 04/27/23.
April 13, 2023 Question: We have a patient with 2 commercial payers (BCBS and Cigna). A consultation code was submitted to BCBS, and they paid according to our contract. However, Cigna is refusing to process the claim since they no longer pay for consult codes. Am I allowed to change the CPT code and rebill...
