CPT or HCPCS Tool?

Question:

We have recruited a new hand surgeon and she frequently applies aluminum finger splints which are molded by the surgeon or her medical assistant. Can we report CPT code 29130 for the application and molding of this splint?

Answer:

Thanks for this great Question:! The application of the splint code 29130 is not reportable for an off the shelf product such as the aluminum splint. Report the appropriate HCPCS code for the supply only.

*This response is based on the best information available as of 07/02/15.

Claw Toe

Question:

We are having some debate about whether CPT code 28285 (hammertoe repair) would be appropriate for fusion of a claw toe? The claw toe is the DIP joint; the hammertoe is the PIP joint. However, code 28285 does not specify which interphalangeal joint is corrected. Should we report 28285 or an unlisted code?

Answer:

A: Thanks for your inquiry. As you note, CPT does not specifically state which joint; it says “e.g., interphalangeal fusion.” The “e.g.” directs us that this is only an example. Therefore, CPT code 28285 is the correct code, assuming the documentation supports the work described by 28285. You will note in Code-X that the claw foot and claw toe diagnosis codes support the medical necessity to report CPT code 28285.

*This response is based on the best information available as of 04/09/15.

Bone Marrow Aspirate for Grafting

Question:

Our surgeon performed a bone marrow aspirate from the iliac crest when performing a spinal fusion. The surgeon gave me CPT code 38230, but I am wondering if this is correct. Can you illuminate this for me?

Answer:

While the aspiration of bone marrow is separately reportable, CPT code 38230 is not the correct code. This code describes the aspiration of bone marrow for transplantation, such as in a bone marrow transplant in an immunosuppressed patient. The correct code, when the aspirate is harvested from a separate surgical site via a separate incision for the intent of a fusion is CPT code 38220, Bone marrow; aspiration only. Append modifier 59 to indicate current procedure service.

*This response is based on the best information available as of 03/12/15.

CMS Denials for CPT code 22633 and 63047

Question:

We reported CPT code 63047 with 22633 for a laminectomy, facetectomy, foraminotomy at the same level to Medicare. Both service were performed at L4-5 and well documented according to the CPT rules. We received a denial for CPT code 63047 as inclusive and have tried to appeal, but Medicare will not reverse the denial.

Answer:

Medicare, via the National Correct Coding Initiative (NCCI) edits, communicated that this code combination, when reported together for work at the same level during the same operative session by the same surgeon, will consider the services inclusive and will not allow payment for both services. Medicare considers the work of the laminectomy and decompression to overlap with the work that is valued into the interbody fusion. While CPT states the two are reportable when the work is over and beyond the work of the discectomy, CMS does not consider the work at the same level overlapping. Moving forward, do not report the 63047 with 22630 or 22633 to Medicare unless the work associated with the laminectomy as defined by CPT code 63047 is performed at a level independent of the interbody fusion (22630 and 22633).

*This response is based on the best information available as of 02/26/15.

Diagnostic Arthroscopy and Meniscectomy

Question:

Can I report a right meniscectomy and left diagnostic knee arthroscopy during the same session?

Answer:

Yes, CPT code 29881 (meniscectomy) and CPT code 29870 (diagnostic arthroscopy) are reportable during the same operative session when they are independently performed on different knees. Use of modifiers may be payor dependent. According to CPT rules, you would report 29881 and 29870-59. Some payors may want the RT/LT modifiers alone; some payors may want the RT/LT and the 59. In 2015, the “X” modifier for separate structure might be required.

*This response is based on the best information available as of 01/08/15.