REIMBURSEMENT ADVOCACY
SANDIE BECKER Certified Medical Coder
Coding Q’s Answers to those tough coding questions... by Sandie Becker Certified Medical Coder
Question: What CPT codes should be used for a tonsillectomy, palatal implants, and uvular radiofrequency reduction performed at the same surgical session? Answer: The tonsillectomy is reported with code 42836, Tonsillectomy, primary or secondary; age 12 or over. The palatal implants and radiofrequency uvular coagulation are not reported with any specific CPT code; therefore, code 42299, Unlisted procedure, palate, uvula, should be reported once to describe both of these procedures. When performing two or more procedures that require the use of the same unlisted code, the unlisted code should be reported only once to identify the services provided. This is due to the fact that the unlisted code does not identify a specific unit value or service. Unit values are not assigned to unlisted codes because the codes do not identify usual procedural components or the effort/skill required for the service. When performing two or more procedures that require the use of more than one unlisted code for different anatomic locations,
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the unlisted code may be reported for each different anatomic location.
Question:
Is CPT code 68815, Probing of nasolacrimal duct, with or without irrigation; with insertion of tube or stent, reported per duct or per eye?
Question:
I billed a claim with CPT 63075 and 22554. The insurance denied the 22554, saying that it was inclusive with the 63075. This has never happened before. What’s up?
When performing the procedure described by code 43770, Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (e.g., gastric band and subcutaneous port components), would laparoscopic repair of a hiatal hernia be separately reported or would this be considered an inclusive service of code 43770?
Answer: Per the CCI edits, 63075, Discectomy, anterior, with decompression of spinal cord and/or nerve root(s) including osteophytectomy, cervical, single interspace, is considered column 1 to 22554, Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below C2. Additionally, as of this year, CPT instructions state “Do not report 22554 in conjunction with 63075 even if performed by separate providers. To report anterior cervical discectomy and interbody fusion at the same level during the same session, use 22551,” Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2.
Answer: Because laparoscopic repair of a hiatal hernia is not integral to the laparoscopic placement of an adjustable gastric restrictive device, it is appropriate to report the hernia repair separately. Modifier 51, multiple procedures, should be appended to the additional procedure code.
For coding questions and reimbursement issues, contact Sandie @ 408/998-8850 or MCMS 831/455-1008 or email sandie@ sccma.org.
Answer: Code 68815 is billed per eye. If the procedure is performed bilaterally, report code 68815 with modifier 50 appended.
Question: