When you need answers to coding, billing, and reimbursement questions, who do you turn to? I am sure it isn’t Ghostbusters!. If you are a Coding Corner member or Executive member, you can get unlimited coding and billing questions responded to for a yearly fee. (See our Coding Corner Webpage for pricing.)
Here are a few Q&As over the last few weeks that have caught my attention and I believe could assist many in their workflows and coding processes. Enjoy!
Answer: “For RPM or any device monitoring, it is Best Practice to report the service when it is completed, as you might have to produce a report if asked. So the date that the patient returns the device or the date that the physician documents the final read is the best date of service to use for billing. You may find another payer that will allow billing on the date of hook up, but that would be rare.”
Answer: 45385 and 45381-51 same polyp or lesion and not bundled as long as it is to help lift the lesion for removal and not to mark the space for a planned future procedure.
Answer: Look at 19300 for mastectomy for breast tissue removed for breast-sized reduction for gynecomastia, but if the breast tissue was removed for a reduction only, and there is no gynecomastia diagnosis, then use code 19318
Answer: For bilateral lower extremity stenting, the CPT® 2022 Professional Edition gives us modifier direction of this scenario at 37221, and 37221.59. It seems like a -50 modifier would be more appropriate since this is a bilateral procedure, but CPT® overrules this coding application in the section for LE interventions.
Answer: 37236 and add-on code +37237 – there is no side-to-side or unilateral or ipsilateral offering. Only initial artery and additional artery.
Answer: If the physician reports a level 5, 99205, or 99215 for a Medicare patient and meets the “maximum” required time allowed for either code and then adds 15 minutes of clinical time, the provider can add the modifier G2212, which is a crosswalk to the add on code for prolonged services +99417. If the patient is a non-Medicare patient, CPT® allows for the minimum time of a level 5 to be met, and the additional 15 minutes, but we submit that Best Practices would be to follow CMS rules on this, as it makes more sense.
Answer: I would recommend using CPT code 37236 for the placement of a stent (or stentgraft) when the device is placed to treat a bleeding vessel. Had this hemorrhaging vessel been somehow treated with coils, it would be coded as an embolization with CPT code 37244. If both coils and a stent were used to treat the same pathology, we would only code for the embolization. Code 37226 is for the placement of a stent in the femoral/popliteal region for the treatment of occlusive disease, while code 37236 is used when a stent or stentgraft is placed for the treatment of non-occlusive disease (bleeding, AVM, AV fistula, aneurysm or pseudoaneurysm [except in the iliacs where 34900 is used]).
Answer: No additional E/M is allowed on this return visit date, and the code billed is: 11102 with work RVU .66
Answer 1: No. When using time to choose your level of service, use only the time you spent on the date of service.
Answer 2: No. The AMA does not require you to provide counseling or coordination of care to choose your procedure code based on the time you spent.
Answer 3: You can still use the time spent face-to-face and for appropriate non-face-to-face activities on the date of the encounter to choose your procedure code. If documenting the service on a different calendar date, do not include the time spent documenting
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Ms. Terry Fletcher is a Healthcare Coding and Reimbursement Consultant, Educator and Auditor based in Southern California. With over 30-years experience, Ms. Fletcher teaches over 100 specialty coding Seminars, Teleconferences and Webinars every year. You can find her CodeCast® podcast series, focusing on Physician Coding, Billing, Reimbursement, compliance, and Medical industry revenue opportunities, on iTunes, Stitcher, TuneIn, and Google Play.
Terry is also an NAMAS Member and Podcast Host, and host of the NSCHBC Edge Podcast.