Multiple Fasciotomies Same Hand for Dupuytren’s

Question:

Our hand surgeon, not infrequently, will perform multiple fasciotomies in the hand for the treatment of Dupuytren’s.  We are reporting CPT code 26045 for each fasciotomy but now we are Question:ing if this is correct or not.  Before we refund claims paid, will you tell us if this code is reportable multiple times in the same hand?

Answer:

CPT code 26045 (Fasciotomy, palmar (eg, Dupuytren’s contracture); open, partial) is reportable one time regardless of how many “fasciotomies” were performed.   The only time this code is reportable twice on the same day is if both hands were treated. The code is a “palmar” code, thus includes all work on the same palm.

*This response is based on the best information available as of 07/26/18.

Total Hip Arthroplasty Question

Question:

We have a patient who underwent an open fixation of a femoral neck fracture five years ago and now presents for a total hip arthroplasty.   Someone mentioned that we should report a conversion to hip arthroplasty but we are not sure if this is a revision of one component plus a hemiarthroplasty?

Answer:

The advice you received related to reporting this as a conversion to total hip arthroplasty is correct.  The patient is not in a global period, so you will report 27132 (Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft).  The concept of reporting the conversion code versus a primary hip arthroplasty is that the patient has had prior open hip surgery, and the value of the conversion code reflects that the procedure is typically more difficult than a primary arthroplasty procedure.

Do not unbundle and report the removal of one component and a hemi-arthroplasty or other revision codes for the described circumstance.

*This response is based on the best information available as of 06/14/18.

Confused about CPT Code 26600

Question:

I am confused on how to report the closed treatment of multiple metacarpal fractures (26600) that are not displaced and treated with the application of a fiberglass short arm cast.    We are receiving denials when reporting the code for each fracture.

Answer:

The official definition of CPT code 26600 (Closed treatment of metacarpal fracture, single; without manipulation, each bone) instructs the physician to report CPT code 26600 for each bone that is fracture and treated without manipulation.

Several years ago, CMS implemented NCCI guidelines instructing that non-manipulative fractures that are treated with a single form of stabilization (e.g. cast) may only be reported as a single fracture.  This NCCI guideline also applies to situations where a patient may have both a displaced and non-displaced fracture treated with the same cast or splint.

The denials are correct if the payor is Medicare based on NCCI edits.  If the denials are coming from private payors, review the contracts to determine if the claim processing rule is agreed to in the contracts.  Appeal all denials to private payors citing CPT rules and hopefully contract agreement language.

*This response is based on the best information available as of 05/31/18.

Joint Injection during the Global Period

Question:

Our physicians want to report 20610-79 when they perform a joint injection for pain following arthroscopic knee surgery.  Is that acceptable?

Answer:

Thanks for your inquiry. Pain management is inclusive to the global surgical package and is not separately reportable.  To append a modifier 79 to a surgical procedure, the procedure is typically at a different anatomic location to support the unrelated component.

*This response is based on the best information available as of 05/03/18.

Diagnostic Ultrasound and Ultrasound Guided Injections

Question:

Our sports medicine physicians are reporting diagnostic ultrasounds (76881) and ultrasound guided injections at the same session, same joint. We are receiving denials as inclusive and are not understanding why they are being denied.

Answer:

Thanks for your inquiry. The ultrasound guided injections (20604, 20606 and 20611) include ultrasound image guidance in the definition of the code.  These injections codes include the work associated with assessing the anatomic structures of the joint and the documentation of a separate report.   Trying to report CPT code 76881 (Ultrasound, complete joint (ie, joint space and peri-articular soft tissue structures) real-time with image documentation)is inclusive to the work valued into the joint injection codes, hence the denial as inclusive.

This is also true of the use of ultrasound guidance with any other injection codes; the diagnostic component is inclusive to CPT code 76942 when this code may be reported with an appropriate injection code.

Medicare also considers the service to be inclusive..  The first reference is from the Medicare NCCI guidelines; the second notation is the introduction of new NCCI PTP edits effective April 1, 2018

Medicare NCCI guidelines also contain the following reference:

Section IX-H, Radiology Services – note: 2018 text revision highlighted in red

9. Evaluation of an anatomic region and guidance for a needle placement procedure by the same radiologic modality on the same date of service may be reported separately if the two procedures are performed in different anatomic regions.  For example, a physician may report a diagnostic ultrasound CPT code and CPT code 76942 (ultrasonic guidance for needle placement…) when performed in different anatomic regions on the same date of service.  Physician should not avoid edits based on this principle by requiring patients to have the procedures performed on different dates of service if historically the evaluation of the anatomic region and guidance for needle biopsy procedures were performed on the same date of service.

Additionally, effective April 1, 2018 , CMS NCCI implemented PTP edits  between CPT codes 20604, 20606 and 20611 and 76881.  CPT code 76881 is now identified a Column 2 PTP edit.

*This response is based on the best information available as of 04/19/18.

My patient’s fallen on the ice and smashed their elbow. Help me select the proper code.

Question:

We received an inquiry from a client where the surgeon wanted to report the repair of the elbow lateral collateral ligament (CPT 24343) along with radial head replacement surgery (CPT 24666) when used for addressing radial head fracture. Can we use this code combination?

Answer:

According to AAOS – Global Service Data GSD) – CPT 24666 (Open treatment of radial head or neck fracture, includes internal fixation or radial head excision, when performed with radial head prosthetic replacement) is the primary code to address this problem.  When reviewing the GSD, it clearly states that CPT 24343 is included with this procedure. As such, it is inappropriate to bill for second code. This gets to the issue that troubles many surgeons.  They would like to be paid for tissues that are divided during the approach used to perform the procedure.  In this particular case, the annular ligament and lateral collateral ligament complex must be incised to perform the radial head insertion, and even if it was torn by the injury (fracture), its surgical repair is still included with the CPT code 24666.

*This response is based on the best information available as of 03/01/18.