Modifier 52 vs. 53

Question:

We are confused about the difference between modifier 52 and 53. What is the difference?

Answer:

Modifier 52 Reduced Services is used when the procedure or surgery is partially reduced or eliminated by the physician. This is used when a procedure has an existing CPT code, but not all of the components of the code were performed. Modifier 52 is not used for unlisted procedures (where there is no existing CPT code to describe the procedure that was performed).

Modifier 53 Discontinued Procedure is used when a procedure is discontinued due to extenuating clinical circumstances or those that threaten the well-being of the patient. An example is during a fem-pop bypass a patient develops an arrhythmia and the procedure is discontinued.

*This response is based on the best information available as of 02/04/21.

Wound Vac Billing

Question:

I’m a general surgeon.  Some of my team are reporting the negative pressure wound therapy codes 97605 and 97606 when applying wound vacs after closing at the completion of their surgical cases.  As a result, I am told by my coders that billing for these wound vacs is not appropriate, since there is a Medicare NCCI edit that bundles this with more comprehensive procedures at the same anatomic area.

The physicians and coders disagree about how to handle these edits.  Some of the physicians believe the wound vacs are billable because they are applied to the skin which constitutes a different body system.  The coders think the wound vacs are dressings which are included in the global surgical fee and would not billable.  After multiple discussions with the physicians and coders, we are unable to provide a definitive answer.   Could I please ask you for your advice regarding this issue? What is the right answer?

Answer:

There are two layers to the issue; CPT rules and payor editing rules.

First, from a CPT perspective, the “wound vac” codes in the range of 97605-97608 are only reportable when placed at an open wound site.  For example, if a physician performed debridement of an open wound, did not close the wound, but placed a wound vac at the debridement site to promote healing, a code in the range 97605-97608 could be reportable if appropriately documented.   Additionally, in the case of delayed closure of the abdomen in damage control surgery, the placement of a wound vac over this open abdomen may be separately reported if documented correctly.

Codes 97605 and 97606 are used for placement of a non-disposable wound vac device, while codes 97607 and 97608 are used if the wound vac is disposable.    The codes are further differentiated by the wound size, either greater than 50 sq cm, or less than or equal to 50 sq cm.

If the wound site has been surgically closed, and a wound vac is placed over the closed wound site, then the use of the wound vac is not separately reportable, as it is being used as a dressing.

In the case of a “codeable” wound vac, payor rules that apply when other services are performed at the same time should also be considered.  For example, debridement code 11044 does not have an NCCI edit with code 97605, thus you should not have any issues reporting the two codes together.  Similarly, you should not find NCCI edits between the lower extremity decompressive fasciotomy codes and the wound vac codes – another type of procedure where it is not unusual to have delayed surgical closure of the wound site.

Damage control surgery, fasciotomy coding and use of wound vacs will be thoroughly covered in the ACS Successful Surgical Coding and Trauma and Intensive Care coding courses offered in several locations in 2021.

*This response is based on the best information available as of 02/06/20.

Renal Angiogram Coding

Question:

Is catheterization separately reported with renal angiograms?

Answer:

No. The renal angiogram codes, see table below, include all catherization.  The codes are selected by order of catheterization and as unilateral or bilateral.  Also, remember that a flush aortogram is included in the renal angiogram codes and not separately reported.

CPT Code	Description
36251	Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, andflush aortogramwhen performed; unilateral
36252	bilateral
36253	Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, andflush aortogramwhen performed; unilateral Do not report 36253 in conjunction with 36251 when performed for the same kidney.
36254	bilateral

*This response is based on the best information available as of 01/09/20.

Providing the exposure for a neurosurgeon. How is it coded?

Question:

A neurosurgeon asked my vascular surgeon to perform the exposure for an anterior spine procedure.  Does he report an exploratory lap his work?

Answer:

No. providing the exposure for a neurosurgeon for an anterior spine  procedure is co-surgery, since code 22558,Arthrodesis, anterior interbody techniqueincludes both the exposure/approach and the work on the spine.  Both surgeons append the co-surgery modifier 62 to code 22558.

*This response is based on the best information available as of 10/17/19.

Reporting 75630 with Extremity Angiograms

Question:

Can code 75630, aortogram, be reported with a unilateral or bilateral extremity angiogram (75710 of 75716)?

Answer:

No. This would constitute double billing of the extremity angiograms.  As shown below, code 75630 includes an aortogram and visualization and interpretation of bilateral lower extremity arteries via a run-of.  For this code, a catheter is advanced to the infra-renal aorta and, without moving the catheter farther down the aorta or in one of both extremities, a run-off of contrast provides imaging of the both extremities to include the iliac and femoral arteries.

Code 75625 is for an aortogram, only. Code 75710 or 75716 is reported in addition to 75625 if the catheter is moved to the aorta bifurcation or into one of both extremities, providing additional imaging of one or both legs.

75630

Aortography, abdominal plus bilateral iliofemoral lower extremity

75625	Aortography, abdominal, non-selective
75710	Angiography, arm/leg(Unilateral)
75716	Angiography, arm/leg(bilateral)

*This response is based on the best information available as of 10/03/19.

Coding TCAR

Question:

What is TCAR and how is it coded?

Answer:

TCAR stands for Transcarotid Artery Revascularization.  It is essentially an open carotid stent procedure. A small incision is made just above the collar bone to expose the common carotid artery. A sheath is placed directly into the carotid artery and connected to flow reversal system, for embolic protection. A stent is placed via that incision to treat carotid occlusion.

This procedure is reported as 37215,Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection.

*This response is based on the best information available as of 06/20/19