Injections with Ultrasound Guidance

Question:

Is it correct CPT coding to report the ultrasound guidance CPT code 76942 when the physician performs tendon injections or a carpal tunnel injection? The CPT code descriptions for 20550, 20551, and 20526 do not include the terms “with ultrasound guidance, with permanent recording and reporting” in their definitions.

Answer:

There is no AMA CPT coding restriction to reporting CPT code 76942 (Ultrasonic guidance for needle placement [eg, biopsy, aspiration, injection, localization device], imaging supervision and interpretation) when ultrasound guidance is medically necessary for needle localization. These codes do not include image guidance as part of the CPT description like the joint injection CPT codes do (20604, 20606, 20611).

Medical necessity must be present and documented to support this additional work and service.

Refer to payor policies for medical necessity requirements for reporting CPT code 76942 in addition to injections that do not include this work as part of their description.

*This response is based on the best information available as of 12/30/21.

Achilles Tendon Debridement/Debulking

Question:

Our surgeon took a patient to the OR for secondary repair of an Achilles tendon tear. He found that the tear was essentially gone and the tissue was very scarred. He performed a debridement and debulking of the scarred tissue. Is this reported with CPT code 11044 or 27654?

Answer:

Thanks for your inquiry. Based on the information you provided, and according to a CPT Assistant article published in April 2020, the correct code is 27654 Repair, secondary, Achilles tendon, with or without graft

CPT code 11044 describes debridement to and including bone. CPT code 11044 would be incorrect for two reasons: 1) bone was not debrided and 2) the CPT Assistant directs the surgeon to use 27654.

*This response is based on the best information available as of 12/16/21.

Nasal Wall Reconstruction

Question:

One of our physicians is scheduling a nasal wall reconstruction with Latera®. He is wanting to use code 30465 (repair nasal vestibular stenosis). I know there is a code for Latera which is 30468 and I feel we should use this code. Please give me your opinion.

Answer:

CPT 30468 was created specifically for procedures such as the Latera implant. It is absolutely incorrect to use 30465 for this procedure.

*This response is based on the best information available as of 12/02/21.

Intraoperative Ultrasound

Question:

I see there is a code for intraoperative ultrasound, 76998. Can I code that when I use ultrasound intraoperatively to assist with tumor removal?

Answer:

No – intraoperative ultrasound is included in the tumor removal surgical CPT code and should not be separately reported by the surgeon.

*This response is based on the best information available as of 12/02/21.

Subchondroplasty

Question:

Our surgeons occasionally perform subchondroplasty procedures. We are reporting this with an unlisted code and are wondering if this is correct.

Answer:

Yes, through the remainder of 2021 you will continue to report an unlisted CPT code. The AMA released a new Category III code in July 2021, but it is not effective until January 1, 2022.

0707T:     Injection(s), bone-substitute material (eg, calcium phosphate) into subchondral bone defect (ie, bone marrow lesion, bone bruise, stress injury, microtrabecular fracture), including imaging guidance and arthroscopic assistance for joint visualization

The following guidelines apply to this new Category III code.

• Do not report 0707T in conjunction with 29805, 29860, 29870, 77002
• For aspiration and injection of bone cysts, use 20615

Source:https://www.ama-assn.org/system/files/cpt-category3-codes-long-descriptors.pdf10/26/2021

*This response is based on the best information available as of 12/02/21.

Fractional Laser Therapy

Question:

We are going to be doing laser therapy for hypertrophic burn scars.  From my understanding we will be using fractional ablative CO2 laser therapy.

Answer:

There are 2 category III codes to report this procedure, 0479T and 0480T. CPT code 0479T is reported for the first 100 cm2 or part thereof, or 1% of body surface area of infants and children and 0480T is the add-on code for each additional 100 cm2, or each additional 1% of body surface area of infants and children, or part thereof. These codes were added in 2018. If the payor does not accept Category III codes, you would report the unlisted code 17999 and submit documentation to the payor for reimbursement. It might be a good idea to check with your individual payors to see if this procedure is covered and if preauthorization is required.

*This response is based on the best information available as of 11/11/21.