Coding Guidance-BIOZORB(Fiducial Marker) placement while doing Mastectomy

 Surgery: Integumentary System

CPT Assistant, November 2013, Volume 23, Issue 11, page 14

 

Question

 

A patient has a left breast segmentectomy for breast cancer. Is it appropriate to report the unlisted code 19499 for placement of the fiducial marker in addition to the segmentectomy procedure?

 

Answer

 

No. The segmentectomy procedure (reported with code 19301, Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy), includes placement of any fiduciary markers.

CODING GUIDANCE-SPINAL HARDWARE INJECTION

 Surgery: Nervous System

CPT Assistant, May 2012, Volume 22, Issue 5, page 14

 

Question:

 

What code(s) may be reported for injection of 0.5% Marcaine and 80 mg of Depo-Medrol to existing spinal hardware (eg, pedicle screws) at L4, L5, and S1 bilaterally? May code 64483 be reported?

 

Answer:

 

No. Code 64483, Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level, represents transforaminal epidural nerve root injection performed in the lumbar region. There is no specific CPT code for the injection of spinal hardware. CPT code 64999, Unlisted procedure, nervous system, would be most appropriate to describe the injections for pain performed outside the foramen, as indicated in the clinical scenario provided in this inquiry. Although three spinal level (L4, L5, S1 bilaterally) injections were performed, code 64999 should be reported only once to represent the multiple injections.

How and when to use Modifier 62?

 Two Surgeons. The individual skills of two or more surgeons are required to perform surgery on the same patient during the same operative session. This may be required because of the complex nature of the procedure(s) and/or the patient's condition and the additional physician is not acting as an assistant at surgery. If the two surgeons (each in a different specialty) are required to perform a specific procedure, each surgeon bills for the procedure with a modifier 62.

Instructions

Co-surgery also refers to surgical procedures involving two surgeons performing the parts of the procedure simultaneously (e.g., heart transplant or bilateral knee replacements). Documentation of the medical necessity for two surgeons is required for certain services identified in the Medicare Physician Fee Schedule Database (MPFSDB).

If the surgery is billed with a modifier 62 and the indicator is 1, the claim will suspend for manual review of any documentation submitted with the claim. If the surgery is billed with a modifier 62 and the indicator is 2, then the payment rule for two surgeons apply.

Correct Use

• Both surgeons must agree to append modifier 62 on their claim
  • Reimbursement at 62.5% of MPFSDB
  • Indicator in MPFSDB must be either 1 or 2
• Procedure code and diagnosis code should be same
• Billed amount might not be same

Incorrect Use

• Modifier 62 must be on both claims or one physician will be paid at 100% and other physician's claim will deny
• Both surgeons must use same CPT code

Claim Coding Example

Dr Smith and Dr Jones (both orthopedic surgeons) performed as co-surgeons an Arthrotomy of the elbow, with capsular excision for capsular release (separate procedure). Co-surgery Indicator 2.

Coding Spinal Neurostimulator-Trial (temporary) vs Permanent

 Spinal Neurostimulator: Removal, Insertion, Replacement, and Analysis (CPT codes 63650, 63655, 63661-63664)

CPT Assistant April 2011, Volume 21, Issue 4, page 10

Question:

May code 63650 be reported for both insertion of a temporary percutaneous electrode array and a permanent percutaneous electrode array?

AMA Response:

Yes. The use of code 63650, Percutaneous implantation of neurostimulator electrode array, epidural, is not altered when the implantation of the percutaneous epidural neurostimulator electrode is performed for the purpose of a "temporary" trial or for "permanent" neurostimulation. The difference between the two procedures is the attachment of the electrode array to an external stimulator unit for trial stimulation as opposed to connecting to an implanted pulse generator or receiver for permanent stimulation. Attachment to an external stimulator unit is considered inherent to the work represented by code 63650. Therefore, it is not appropriate to report code 63685, Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling.

However, if the percutaneous electrode array is attached to an implanted spinal neurostimulator pulse generator or receiver, then code 63685 would be reported in addition to code 63650, for the insertion or replacement of the pulse generator or receiver. Code 63685 includes the creation of a subcutaneous pocket made to house the stimulator and tunneling of the electrodes to the pocket. The generator is then placed in the subcutaneous pocket, lead impedances are tested to verify proper connection, and the device is programmed to begin stimulation.

HOW TO CHECK MEDICARE LCD?

 STEP 1: Open this link(https://www.cms.gov/medicare-coverage-database/).Always open in Internet Explorer.

STEP 2: Open the advanced search as shown below:

STEP 3: Select local coverage documents(LCDs & Articles) and select state from drop down list and enter CPT code and press "SEARCH" as shown below:

FINAL STEP: Open the LCD based on the MAC contractor name as shown below: