August 3, 2023 Question: When reporting an injection of a steroid of the brachial plexus can I report imaging such as ultrasound guidance? Answer: CPT code 64415 is reported for a injection of an anesthetic agent and/or steroid of the brachial plexus. Per CPT imaging guidance is included in the code and cannot be reported...
July 6, 2023 Question: How is RFA rhizotomy of the trigeminal nerve at the second and third division branches of the foramen ovale? The diagnosis was Trigeminal Neuralgia Answer: This procedure is coded as 64605, Destruction by neurolytic agent, trigeminal nerve second and third division branches at foramen ovale. Code +77002 may also be reported...
June 8, 2023 Question: What CPT code do we use when our physician performs an SI joint injection using ultrasound guidance? CPT code 27096 states with fluoroscopy or CT guidance. Answer: CPT instructs to report CPT code 20552 for unilateral or bilateral SI joint injections if CT or Fluoroscopic imaging is not used. CPT code...
May 11, 2023 Question: What does “separate procedure” mean when it follows a CPT code description? Answer: Per CPT : Some of the procedures or services listed in the CPT codebook that are commonly carried out as an integral component of a total service or procedure have been identified by the inclusion of the term...
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...
March 16, 2023 Question: In 2023 will the level of service be determined by history, exam and medical decision making or will this change. I have heard it is changing. Answer: Beginning January 1, 2023 consultation codes 99242-99255) for both inpatient and outpatient services will be based on medical decision making or time. However, keep...
February 16, 2023 Question: What is the difference between an implant and a foreign body? Answer: On page 74 of the Current Procedural Terminology (CPT) Professional Edition 2023, the definition was added to the guidelines. “An object intentionally placed by a physician or other qualified heal care professional for any purpose (eg, diagnostic or therapeutic)...
January 19, 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...
December 15, 2022 Question: I am a contracted physician with a group practice (Practice A) in our town. I have an opportunity to contract with another practice (Practice B) not in the same town, but near enough that my patients could see me in either location. My question has to do with the definition of...
November 17, 2022 Question: Can I bill an office visit in the global period if the diagnosis is different from why I did the original procedure? Answer: Yes, as long as the diagnosis is not for a related issue (e.g., complication from the original procedure). The documentation must be clear that the condition is unrelated...
