October 6, 2022 Question: A retrosigmoid craniotomy was performed with microvascular decompression of the 5th nerve. The diagnosis was Trigeminal Neuralgia. How is this coded? Answer: This procedure is reported with code 61458, Craniotomy, suboccipital, for exploration or decompression of cranial nerves. *This response is based on the best information available as of 10/06/22. ...
September 22, 2022 Question: In a recent head trauma case, a decompressive craniectomy was performed with a partial temporal lobectomy, due to extensive damage. A hematoma was also evacuated. can we bill for the 61323 decompressive craniectomy code with lobectomy since only a partial lobectomy was done? And what about cooing for the hematoma evacuation?...
September 8, 2022 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...
August 25, 2022 Question: If the exposure is thoracic, for example in a thoracic corpectomy, and the documentation states a costotransversectomy was performed, can that be billed separately? Answer: Costotransversectomy (e.g., 21610) is included in a thoracic corpectomy and not separately billed. Note also that 21610 states “separate procedure” so it is never billed with...
August 11, 2022 Question: How do you report a spinal procedure for example, arthrodesis or laminectomies when two spinal are involved. For example., both thoracic and lumbar spine? Answer: Report one stand-alone/primary code even when the procedure crosses spine junctional levels. Use the stand-alone code for the spine region where the majority of the procedure/levels...
July 28, 2022 Question: Can code 20680, removal of implant, be used for removal of a previously placed intervertebral device, such as a PEEK cage? Answer: No. There is no code for removal of an intervertebral device – this would be part of an exploration of arthrodesis or new arthrodesis, if performed. Do not use...
July 14, 2022 Question: I placed posterior percutaneous screws and rods without an arthrodesis. I know I have to use an unlisted code, 22899. How should I price it? Answer: Good question. Let’s assume you’re doing +22842 (posterior instrumentation, 3-6 segments) which is an add-on code. Add-on codes are valued for only the intra-operative portion...
June 30, 2022 Question: Can I use modifiers on an unlisted code? Answer: There is not a single right answer to this question. CPT said, in an old CPT Assistant, that generally modifiers are not appended to an unlisted code. Payors have their own rules. For example, some payors will accept modifier 62 (two surgeons/co-surgery)...
June 16, 2022 Question: The patient had a re-do laminectomy for stenosis at L3-L4. Can code 63042 be used for this procedure? Answer: No. CPT 63042 is intended for a re-do discectomy and would be inappropriate to use for a re-do laminectomy. Rather, use 63047 for this service and modifier 22 may be appended if...
June 2, 2022 Question: Since we have to bring the patients back in for COVID testing and H&P for Joint Commission, can we bill for this visit even though it’s another pre-op visit? Answer: Yes, since the original surgery was canceled and is now under consideration for rescheduling due to the pandemic and needs to...
