Choose your specialty from the list below to see how our experts have tackled a wide range of client questions.
Looking for something specific? Utilize our search feature by typing in a key word!
Procedure Coding
What is the difference between a biopsy and removal when it comes to dermatology.
Question:
What is the difference between a biopsy and removal when it comes to dermatology.
Answer:
A biopsy is a sample of a suspicious lesion on the body and the tissue is sent to a laboratory for testing. Where shave excisions are removals of lesions without taking the full thickness of the skin. These codes include local anesthesia. The wounds do not require suture closure.
*This response is based on the best information available as of 12/28/23.
Intracranial Endovascular Venous Thrombectomy
How is an Intracranial endovascular venous thrombectomy coded?
Question:
How is an Intracranial endovascular venous thrombectomy coded?
Answer:
There are no intracranial venous endovascular codes, so this must be reported as an unlisted code, 64999. If performed and documented, a venogram, and the venous catheterization may also be reported.
*This response is based on the best information available as of 12/28/23.
E&M with Injections: Two Diagnoses
If we have an established patient where the physician evaluates the patient and decides to give an injection. The physician documents two diagnoses. May we report an E&M with the injection because we have two diagnoses?
Question:
If we have an established patient where the physician evaluates the patient and decides to give an injection. The physician documents two diagnoses. May we report an E&M with the injection because we have two diagnoses?
Answer:
An E&M is reportable with the injection when the significant separate service rules are met.
Two answers apply:
- We do not recommend reporting the E&M if the second diagnosis is at same location or joint that is being injected. In this case, a second diagnosis does not meet the “separate service” part of the modifier 25 definition.
- We recommend reporting the E&M-25 if the second diagnosis if:
- The second diagnosis is in a separate anatomic location from the injection site, and
- The second condition is evaluated and managed.
E/M Coding for Emergency Surgery
Under the revised 2023 EM guidelines what E/M code would be supported for seeing a patient in the the ED for a ruptured abdominal aorta aneurysm (AAA) and taking them emergently to surgery for repair?
Question:
Under the revised 2023 EM guidelines what E/M code would be supported for seeing a patient in the the ED for a ruptured abdominal aorta aneurysm (AAA) and taking them emergently to surgery for repair?
Answer:
This scenario would support , 99223, the highest level of Initial hospital care. Based on:
- High Problem-Acute or chronic illness or injury that poses a threat to life or bodily function and,
- High Risk- Emergency surgery
Remember, only 2 of the 3 medical decision-making elements are needed to support a level of E/M.
E&M With Injection: What If We Want to Code Based on Time?
We have a recent case where a patient returned with return of pain about five months after a previous injection. The physician evaluates the patient noting no new injury, no changes in his exam findings and decides to re-inject the patient’s knee without additional treatment options discussed. We shared with the physician that the E&M was not separately reportable. The physician asked, ‘what if I code based on time, is it reportable then?” We are unsure if this makes a difference or not. Will you address this question?
Question:
We have a recent case where a patient returned with return of pain about five months after a previous injection. The physician evaluates the patient noting no new injury, no changes in his exam findings and decides to re-inject the patient’s knee without additional treatment options discussed. We shared with the physician that the E&M was not separately reportable. The physician asked, ‘what if I code based on time, is it reportable then?” We are unsure if this makes a difference or not. Will you address this question?
Answer:
KZA agrees with your initial recommendation based on the information provided. In terms of your specific question, whether the rules associated with modifier 25 (significant, separate service) vary based on the methodology supporting a level of service, the answer is “no”.
The E&M guidelines address how to select a level of service based on either MDM (Medical Decision Making) or Time. The rules associated with modifier 25 are specific to the E&M meeting the significant separate service rules, not the methodology of E&M code selection. In the scenario provided, the significant separate services rules are not met; report the injection and drugs, as appropriate.
Cholecystotomy Procedure
How should you code an open cholecystotomy, with a drain placement and a biopsy of the gallbladder wall is performed. Can the biopsy of the gallbladder be separately reported?
Question:
How should you code an open cholecystotomy, with a drain placement and a biopsy of the gallbladder wall is performed. Can the biopsy of the gallbladder be separately reported?
Answer:
No, the biopsy of the gallbladder wall is not separately reportable this is bundled and inclusive to the cholectstotomy. The correct code to report for this procedure would be CPT 47480,Cholecystotomy or cholecystostomy, open, with exploration, drainage, or removal of calculus (separate procedure).
*This response is based on the best information available as of 12/14/23.
