May 11, 2023 Question: What code is used to make an incision over the femoral artery to evaluate for injury, and explore it without any repair? Answer: Use code 35703, Exploration not followed by surgical repair, artery; lower extremity (eg, common femoral, deep femoral, superficial femoral, popliteal, tibial, peroneal) *This response is based on the...
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 13, 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...
March 30, 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: Our vascular surgeon did a single intervention on a lesion that was at the juncture of the femoral/popliteal and tibial/peritoneal territories. Can we charge for two interventions? Answer: Lesions that extend across the margins of one vessel vascular territory into another, but can be treated with a single therapy are reported...
March 2, 2023 Question: During a catheterization the surgeon performed a venogram. I don’t see that these procedures are bundled, is that correct? Answer: Venous catheterization codes are separately reported with venograms, unless they are performed at the same session with an intervention that includes catheterization. *This response is based on the best information available...
February 16, 2023 Question: Does TEVAR allow for billing of catheterization and intervention? Would a 59 modifier be needed? Answer: Yes, billing for a catheterization in addition to the TEVAR is allowed. And no, a modifier 59 is not needed as these two codes do not bundle. *This response is based on the best information...
February 2, 2023 Question: When does a nonselective catheterization become a selective catheterization? Answer: If the catheter (not just the wire) is manipulated into another vessel beyond the puncture site or beyond the aorta, then it is coded as a selective catheterization. *This response is based on the best information available as of 02/02/23. ...
January 19, 2023 Question: We are confused about the difference between modifier 52 and 53. What is the difference? Answer: Modifier 52 Reduced Services is used when the procedure or surgery is partially reduced or eliminated by the physician. This is used when a procedure has an existing CPT code, but not all of the...
December 15, 2022 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...
