The Vascular Surgery MVP Feedback from the CMS public comment period has been posted to the CMS website. The SVS is very grateful for all the feedback that was given. After reviewing the MVP candidates, the feedback for the Vascular Surgery MVP was consistent with other MVP candidates and issues previously identified by CMS.
Coding is a complicated aspect of all medical fields. To help vascular surgery professionals better understand the ins and outs of coding, the SVS posts frequently asked questions and their answers on this webpage. Please note that this information is provided for educational purposes only, based on regulations at a particular point in time. Final decisions on how to code are ultimately up to the provider.
If you have questions of your own, please submit them using the form below.
Q: Does TEVAR allow for billing of catheterization and intervention? Would a 59 modifier be needed?
A: Yes, billing for catheterization in addition to the TEVAR is allowed. And no, a modifier 59 is not needed as these two codes do not bundle.
Answer created in April 2023.
Q: How do I code for an isolated iliac artery aneurysm treated endovascularly with an iliac endograft?
A: These codes were revised in 2018 to include either ruptured or unruptured iliac aneurysms. In addition, non-selective catheterization and radiological supervision and interpretation are now inclusive. Refer to the CPT codebook for detailed guidelines on the use of these codes. Here are the full code descriptions.
34707
Endovascular repair of iliac artery by deployment of an ilio-iliac tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, and all endograft extension(s) proximally to the aortic bifurcation and distally to the iliac bifurcation, and treatment zone angioplasty/stenting, when performed, unilateral; for other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, arteriovenous malformation)
34708
Endovascular repair of iliac artery by deployment of an ilio-iliac tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, and all endograft extension(s) proximally to the aortic bifurcation and distally to the iliac bifurcation, and treatment zone angioplasty/stenting, when performed, unilateral; for rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, arteriovenous malformation, traumatic disruption)
Note: For bifurcated iliac endografts, refer to codes 34717 and 34718.
Answer created in November 2023.
Q: Is catheterization separately reported with renal angiograms?
A: No. The renal angiogram codes, see table below, include all catheterization. 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, and flush aortogram when performed; unilateral |
| 36252 | bilateral |
| 36253 |
Supraselective 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, and flush aortogram when performed; unilateral
|
| 36254 | bilateral |
Answer created in November 2023.
Q: The surgeon used a stent and then inserted an embolization coil for an aneurysm. Are both billable?
A: If the stent is placed to provide a latticework for deployment of the embolism coil, then no. You would just bill for the embolization. If the stent itself is the sole definitive procedure to treat the aneurysm, then only the stent should be billed.
Answer created in April 2024.
Q: My patient needs a fistulogram in the hospital as an outpatient and the hospital requires that I document an H&P, can I bill an EM for the required H&P?
A: No, H&P are not billed separately from the procedure(s) being performed.
Answer created in January 2025.
Q: If you see a Medicare patient as an inpatient consultation, what code would you bill for the EM?
A: Initial hospital code with the appropriate level based on MDM or Time.
Answer created in January 2025.
Q: What information needs to be documented in the body of the operative report for endovascular procedures?
A: Documentation must include a thorough description of the procedure detailing vascular access points, catheterizations including the end point of all catheterizations, description of all interventions performed including placement of any prosthesis, results of the intervention, percentage of residual stenosis for all vessels treated and any attempted procedures that were not successful or not able to be completed. Radiological supervision for diagnostic angiograms with rationale, vessels visualized and findings should also be detailed in a separate paragraph.
Answer created in October 2024.
Q: With the 2021 and 2023 Guideline changes, is it necessary to document an HPI and Exam when neither counts towards the level of service?
A: As described in the most recent AMA E/M guidelines, documentation of a history of present illness (HPI) and an exam are no longer required to contribute to the level of an E/M service. Today, documentation of medical decision making, or time are the sole determinants supporting a level of E/M. E/M documentation should include a medically appropriate history and examination. While the nature and extent of the history and exam is to be determined by the clinician, they add to the medical necessity of the visit and provide a more complete representation of the patient condition for continuity and coordination of care with other clinical providers.
Answer created in October 2024.
Q: Is there a difference between a pre-operative diagnosis and a post-operative diagnosis?
A: Pre-operative diagnosis is based on the “Reason for the surgery” or the condition affecting the patient leading to the necessity of the surgery. Underlying co-morbidities that can affect the surgical outcome or represent a risk to the patient can also be included but the documentation must support their relationship to the patient risk.
Post-operative diagnoses are based on the findings determined during the surgical procedure. Post-op diagnosis may be the same as the pre-op diagnosis or may be more definitive.
Answer created in October 2024.
Q: If the details of a procedure documentation do not match the listed procedure/operation that was planned, which procedure code should be selected?
A: CPT codes are always chosen based on the documentation within the detailed portion of an operative record. If the details within the body of the report do not match the “procedure title” listed in the beginning of the operative report, the provider should be queried for clarification and a possible addendum to the record if necessary.
Answer created in October 2024.
Q: What is a “unique test”?
A: The difference between single and multiple tests is defined by CPT code. For example:
Answer created in September 2024.
Q: Can a case worker or social worker be considered an independent historian?
A: Yes, an individual who provides a history in addition to or in lieu of a patient providing a complete and reliable history would be considered an independent historian.
Answer created in September 2024.
Q: If I order a lab test to be performed and at the next visit I review the lab test results, can the review count as data/test reviewed?
A: No, test review is considered inherent to the order and cannot be counted as data reviewed at the subsequent visit.
Answer created in September 2024.
Q: We have an established patient with chronic PAD that now presents with continued symptoms of claudication. Would this problem be considered moderate or high complexity?
A: A chronic condition with progression or exacerbation (continued symptoms, not at their treatment goal) would be considered Moderate complexity under the Number and Complexity of Problems Addressed column.
Answer created in August 2024.
Q: I provided independent interpretation of an ultrasound that was performed at an outside facility, and then had a telephone discussion with the patient's podiatrist regarding the patient’s condition. What level would this be considered for data?
A: Independent interpretation of tests performed by another provider and also discussion of management with an external physician would meet category 2 and category 3 for Data thereby equating to Extensive/High for Data Reviewed in the data element of medical decision making.
Answer created in August 2024.
Q: Can our vascular surgeon bill for moderate sedation if an RN was present to observe and monitor the patient?
A: Yes; an RN has the knowledge and experience to observe and monitor the patient's vital signs, including BP, oxygen levels, heart rate and level of consciousness under the direct supervision of the physician.
Answer created in June 2024.
Q: Our vascular surgeon was called into the OR by an orthopedic surgeon who was treating a patient for a traumatic injury of the lower left extremity as the result of an MVA. While stabilizing an open tib-fib fracture the ortho surgeon identified a transected posterior tibial artery and called the vascular surgeon for an intra-operative consult. The vascular surgeon quickly repaired the injured artery and then turned the patient back over to the ortho surgeon. Can we bill the vascular surgeon as co-surgeon?
A: No; co-surgery involves both surgeons performing integral portions of the same procedure (CPT code). In this case, the vascular surgeon is the only one repairing the injured vessel so the vascular surgeon would document his/her own op note with the details of the vascular procedure and code accordingly (likely CPT code 35226).
Answer created in June 2024.
Q: Our vascular surgeon was called in to consult for an inpatient, along with other specialists on the same date. The 2023 guidelines on inpatient consults are a little confusing. Can we bill a consult since other physicians are consulting on the same day?
A: Yes, if the patient hasn’t received any face-to-face professional service from your vascular surgeon or other physicians (or NP, PA) in your practice of the exact same specialty during the patient’s stay.
Answer created in May 2024.
Q: Medicare says to only code the initial admission code if the patient is admitted and discharged in under 8 hours. Do commercial insurance companies follow the same rule?
A: Yes. In CPT 2024 this question is addressed and gives examples of same date and different calendar date scenarios. And don’t forget that in 2023 Observation and Inpatient codes were combined and are now reported with 99221-99223.
Answer created in May 2024.
Q: As in most clinics, we see a lot of patients with multiple comorbidities listed in their personal history within the EHR. My providers pull these conditions into the current progress note and expect to get MDM credit for these conditions under the problem-addressed component of the E/M level. Is this correct?
A: Under the problem element of MDM, a problem isn’t considered “addressed” unless the physician documents his/her evaluation of the problem and how or why the condition/disease is being treated/managed. Remember, however. that under the Risk element of MDM, comorbidities documented as potentially impacting the condition/disease/symptom being treated or managed, may impact the E/M level selected.
Answer created in April 2024.
Q: My coding department says that I get credit for the order of an MRI and get credit for the interpretation during the same visit. Is this true?
A: You can get credit for both an order and independent interpretation for the same visit if 1) you are not billing for the global service or the professional reading with modifier 26 (meaning an outside or external facility was used) and 2) documentation supports that you visualized the images and documented a summary of your findings. This does not have to be documented in a separate report but does need to be noted.
Answer created in April 2024.
Q: I sent a patient out to the hospital for a CTA and the patient brought in the actual images and the radiologist’s report for me to review. Can I charge 76140 (Consultation on X-ray examination made elsewhere, written report) when I personally interpret those images and write my own report?
A: No. This code is used by a radiologist who does an overread of an imaging study and provides a written report after reviewing an x-ray exam that was performed elsewhere. You do receive credit for ordering the CTA at the time of the visit when it was ordered. You do not receive additional E/M credit for reviewing the findings with the patient at a later visit.
If you did not separately bill for the global or professional component for the reading, you can receive credit for an independent interpretation of the films. This needs to be clearly documented that the images were personally viewed by the provider and the findings of the provider.
Answer created in April 2024.
Q: We have several patients that require translators to assist in getting not only the history but communicating throughout the visit. Can we receive credit under Data and count them as independent historians?
A: No, neither translators nor interpreters are considered independent historians as they are only communicating what the patient said, not additional information regarding their medical history. CPT gives us the definition of an independent historian as an individual (eg, parent, guardian, surrogate, spouse, witness) who provides a history in addition to a history provided by the patient who is unable to provide a complete or reliable history (eg, due to developmental stage, dementia, or psychosis) or because a confirmatory history is judged to be necessary.
Answer created in March 2024.
Q: Does the admitting diagnosis always need to be included on claims for subsequent hospital visits if the problem addressed changes or is not the same as the admitting problem?
A: For hospital inpatient or observation subsequent care visits, the problem addressed is the problem status or diagnosis on the date of encounter. Physicians should only list problems that are directly treated, managed, or affect the medical decision-making for the condition(s) treated. These problems may be significantly different from the problem addressed on the admission.
Answer created in March 2024.
Q: Since the follow-up consultation codes have been deleted for quite some time, what code set should we use for a follow-up consultation?
A: CPT instructs practitioners to use the subsequent hospital inpatient or observation care codes for follow-up consultations or daily visits when the patient is not within a global surgical period.
Answer created in February 2024.
Q: The new CPT rules allow practitioners to bill for 2 E/M services on the same date if 2 visits are performed. Does Medicare follow this new guideline as well?
A: While CPT does allow billing for 2 distinct E/M services provided in different settings on the same day (e.g., in office visit in the morning then a hospital admission in the evening), Medicare does not allow billing for more than 1 E/M service on a given day.
However, Medicare does allow physicians and qualified healthcare providers (QHPs) to combine documentation for both visits on the same date to meet a single level of service from the highest code category for the date (e.g., office visit and inpatient admission – the billable code would from the 99221-99223 category).
Answer created in February 2024.
Q: Can we give the physician credit for Problems Addressed if comorbidities are simply listed within the Assessment and Plan?
A: Comorbidities and underlying diseases, in and of themselves, are not considered in selecting a level of E/M services unless they are specifically addressed by the provider. Documentation should indicate the comorbidity’s impact on the condition treated.
Answer created in January 2024.
Q: We have an office-based vein center and have heard that something called LCDs should be followed before a procedure is performed. What are these and how do we integrate them into our office processes?
A: An LCD is a Local Coverage Determination. These are medical coverage policies developed by regional Medicare carriers and Medicare Administrative Contractors (MAC) to determine whether there is medical necessity for a vein procedure. Every MAC and every private payor have published detailed criteria that must be met before veins can be considered symptomatic enough to justify interventions such as endovenous ablation. These criteria typically include conservative therapy requirements, vein size, number of ultrasounds performed, details of the ultrasounds, CEAP classification, and much more.
If these criteria are not followed, payors can demand refunds upon case review. This can occur months or even years after the intervention is performed, even if it was pre-certified. Whether you are a “vein only” center or have vein procedure as part of a larger patient population, you cannot afford to ignore these payor policies.
Answer created in December 2023.
Q: Now that the public health emergency is over and telehealth flexibilities have been extended, can we use any app or platform to conduct a telemedicine visit?
A: No. Some telehealth flexibilities are in place until December 31, 2024. However, as of May 11, 2023, HIPAA approved telehealth platforms are once again required for conducting audio and video telehealth visits. Skype, FaceTime, Facebook Messenger Chat, and Google Hangouts video are no longer approved platforms.
Answer created in December 2023.
Q: Can a physician bill for same day observation codes if she only sees the patient once during the day?
A: No. Codes 99234, 99235, 99236 require two or more encounters on the same date of which one of these encounters is an initial admission encounter and another encounter being a discharge encounter.
Answer created in October 2023.
Q: I heard that I can now count the time I spend documenting in the patient’s EHR when I bill by Time, is that true?
A: Yes, it is true. Time for documenting clinical information in the electronic or other health record (for the E/M only) is allowed to count for total time. Time spent documenting in the medical record for other billed services is not counted toward the time spent on the E/M office visit.
Answer created in October 2023.
Q: I have 2 vascular surgeons from the same practice that want to bill co-surgery for a complex open abdominal aneurysm repair. They both performed the same code but say that it should be co-surgery because it was complex and needed both surgeons. Can we bill with modifier -62?
A: The surgery described does not support the definition of a co-surgery (each surgeon performs distinct work described within the same code) and should be billed as a primary and assistant surgeon. Co-surgery implies two surgeons with a different skill set, i.e. different specialties, each provider performing distinct portions of the case, and each documenting their portion in separate operative reports. Also, Medicare and other payors may require that surgeons be of different specialties when billing for co-surgery. Note that the federal Office of Inspector General (OIG) has identified co-surgery as an area of potential overpayment/incorrect payment, making this an audit target. For more information go to the link below:
https://oig.hhs.gov/oas/reports/region1/12000503.asp
Answer created in April 2023.
Q: Can we bill for all vessels mentioned if they are documented within the angiogram?
A: No. You should only bill for vessels that are targeted and are medically necessary. Documentation alone doesn’t mean that procedures are always separately billable.
Answer created in April 2023.
Q: A patient who had a lower extremity bypass develops a wound during the post-op and is taken to the OBL for an angioplasty. Can we bill the angioplasty procedure?
A: Yes, the angioplasty can be billed with modifier 78 appended for an unplanned return to the OR during the post-operative global period.
Answer created in January 2025.
Q: Can add-on code +75774 be used for veins or only arteries?
A: CPT add-on code +75774 may be reported for the study of either arteries or veins. The CPT Assistant Editorial Board agrees with the specialty societies coding guidance and the vascular procedures subsection guidelines in the radiology section of CPT have been revised for clarification.
Answer created in January 2025.
Q: If a stent is placed in the common femoral artery and an atherectomy is performed in the popliteal artery, can both codes be billed?
A: The femoral/popliteal is one territory, so angioplasty, atherectomy and stent are reported with one code regardless of the number of interventions performed. CPT code 37227 represents stent and atherectomy within the same vessel and also includes angioplasty when performed.
Answer created in July 2024.
Q: How do we code for intravascular ultrasound of lower extremity vessels? And can it be billed along with placement of a lower extremity stent?
A: Intravascular Ultrasound (IVUS), CPT code +37252 (noncoronary) and +37253 (noncoronary) for each additional vessel, can be coded when vessels are examined during a diagnostic procedure or before, during or after a therapeutic intervention (e.g. stent or stent graft, angioplasty, atherectomy, embolization, thrombolysis, transcatheter biopsy). However, if a lesion extends across the margins of one vessel into another, only one code should be reported. These are add-on codes so they must be reported with the appropriate base code. IVUS is included in the work of CPT codes 37191, 37192, 37193, 37197 for intravascular vena cava filter (IVC) and should not be reported separately with those procedures.
Answer created in July 2024.
Q: How do we code for lower extremity Intravascular Lithotripsy (IVL)? Can physicians use HCPCS codes C9764-C9767?
A: There is currently no CPT code to represent physician coding for Intravascular Lithotripsy of the lower extremities. Physicians should not report the facility codes C9764-C9767, instead report these procedures with unlisted vascular CPT code 37799 and compare to an angioplasty code for the same vessel.
Answer created in July 2024.
Q: When coding lower extremity re-vascularization procedures, can the tibial-peroneal trunk, posterior tibial and anterior tibial arteries all be coded separately?
A: The tibial peroneal trunk (TPT) splits into the peroneal and posterior tibial (PT) arteries. The anterior tibial artery branches off the popliteal artery above the tibial peroneal trunk. Therefore, when coding, the anterior tibial artery is considered separate from the TPT, however, the PT is considered a continuation of the TPT and not a separately coded vessel. So, if the anterior tibial, the posterior tibial, and the peroneal arteries are all treated, for example with atherectomy, each may be separately reported.
Answer created in July 2024.
Q: What are the requirements to code 76937 for ultrasound guidance for vascular access?
A: CPT code 76937 requires documentation of the following: ultrasound evaluation of potential access sites, localization and documentation of vessel patency, and the permanent recording and report must be noted and stored.
Answer created in June 2024.
Q: Do you code bilateral catheterization codes with modifier 50?
A: Catheterization codes below the diaphragm can be coded with bilateral modifier 50, however, catheterization codes above the diaphragm should be coded with modifier 59 on the second code. (ex. Lower extremity 36245-50, upper extremity 36215, 36215-59).
Answer created in June 2024.
Q: Our surgeon performed an aortogram with run-off to bilateral lower extremities. He then performed interventions in the left SFA and the left peroneal arteries. My question is regarding documentation of the diagnostic imaging. Can he also bill for a diagnostic angiogram? What about catheterization to get there?
A: Diagnostic imaging during lower extremity arterial revascularization procedures such as stent and atherectomy, may be separately billed at the same session as the intervention when:
Although CPT considers only catheter- based angiograms as a prior study, Medicare considers a CTA to be a prior diagnostic study. Catheterization is always bundled with lower extremity arterial interventions, including angioplasty, stenting or atherectomy.
Answer created in May 2024.
Q: When does a nonselective catheterization become a selective catheterization?
A: If the catheter (not just the wire) is manipulated into another vessel beyond the puncture site or beyond the aorta, then it is coded as a selective catheterization.
Answer created in April 2023.
Q: During catheterization, the surgeon performed a venogram. I don’t see that these procedures are bundled, is that correct?
A: Venous catheterization codes are separately reported with venograms unless they are performed at the same session with an intervention that includes catheterization.
Answer created in April 2023.
Q: I’m confused about how to code the catheterization with the new EVAR codes. We still do a bilateral catheterization of the aorta. Can we code 36200 bilaterally?
A: The new EVAR codes, updated and completely changed in 2018, bundle the aorta catheterization with the main body placement, so 36200, non-selective arterial catheterization, is no longer separately reported. This is just one of many changes that were made to coding for EVAR.
Answer created in March 2024.
Q: I’m new to vascular coding, can we bill for vascular access for a catheterization? The provider documents this, so I’m thinking I am missing a code.
A: No, vascular access itself is not separately billable with a catheterization. However, the provider must document the vessel accessed, what side of the body (RT or LT), and the end point of the catheter so the proper catheterization codes can be billed. Remember, some interventions (cervico-cerebral angiograms, carotid stenting on the same side as the stenting, and more) include catheterization and it would not be separately billable.
Remember, if ultrasound is used to facilitate vascular access, it can be billed with code 76937, assuming access and patency is documented and a permanent recording is retained.
Answer created in March 2024.
Q: Are there any vascular CPT codes that still allow separate reporting of selective and non-selective catheterization codes?
A: Yes, the following procedures still allow separate reporting of catheterization codes:
Answer created in February 2024.
Q: Is an angiogram of the iliac arteries reported with the pelvic angiogram code, 75736?
A: No, code 75736, Angiography, pelvis, selective or supraselective is only reported with selective or supraselective catheterization of the internal iliac arteries (hypogastric arteries) and interpretation of pelvic vasculature.
Answer created in November 2023.
Q: The physician performed right and then left carotid stent insertion with embolic protection. The right carotid stent was done first and then 6 weeks later the left side was done. Which modifier should be used on the second carotid stent?
A: The second carotid stent is an unrelated procedure performed during the global period. Append a modifier 79 to code 37215 to indicate this unrelated procedure. Even though these are the same procedures reported with the same CPT code, they are performed at different anatomic locations and therefore are unrelated.
Answer created in January 2024.
Q: How do we code multiple embolectomies of the aorta when using 34201? Do we code units by the number removed?
A: 34201, Embolectomy or thrombectomy, with or without catheter; femoropopliteal, aortoiliac artery, by leg incision, is billed once per leg incision no matter how many emboli are removed from each incision. If this is performed bilaterally (two leg incisions), then bill 34201 with mod -50.
Answer created in October 2023.
Q: I was called to consult on a Medicare patient who was admitted several days earlier. This is my first visit with the patient, would this be considered initial or subsequent because the patient has been in the hospital for several days?
A: The first hospital visit with a Medicare patient (or any patient) by you/or another member of your practice of the same specialty would be an Initial Hospital visit, even if it’s not the first day the patient is in the hospital.
Answer created in September 2024.
Q: Documentation indicates that our provider made a decision to move forward with lower extremity bypass for a patient and the discussion included the necessity for the patient to stop their long term anticoagulant use for 2 days prior due to increased bleeding risk. The surgeon indicated this as contributing to the risk of the procedure. Would this detail of discussion be considered high risk?
A: Yes, decision for major surgery with patient identified risk factors or procedure risk factors would support High in the Risk of Complications/Morbidity/Mortality of Patient Management.
Answer created in August 2024.
Q: What constitutes prescription drug management to support a moderate risk/plan?
A: Prescription drug management includes: evaluating if a prescription is appropriate for a specific condition, starting a patient on an new RX, changing the dosage of an existing medication, discontinuing a prescription (even if short term for a surgical procedure). Best practice includes naming the drug and dosage in the documentation.
Answer created in August 2024.
Q: Does it matter that the open exposure codes are now add-on codes? Does that change payment or coding in any way?
A: Yes, this change has both coding and payment implications. In terms of coding, the open exposure codes can now only be reported with a primary code; the main body EVAR code. If a different provider performs the open exposure, he/she would also have to report as assistant on the EVAR main body code to report the add-on exposure code.
From a reimbursement perspective, add-on codes should be paid as 100% of the allowable and are not subject to the multiple procedure payment reduction of 50%. For example, when femoral exposure, 34812, was a primary code, it received a 50% reduction when performed with an EVAR and when performed bilaterally. As an add-on code, it is paid in full. To avoid a payment reduction, CPT advises that all exposure codes for EVAR be reported with units instead of a 50 modifier when performed bilaterally.
Answer created in February 2024.
Q: Can we bill the 92242 for the indocyanine green injection intraoperatively, for example, to assess perfusion after a procedure? Can we bill for the injection of the dye using 15860?
A: No, this service is included in primary surgery and not separately reported.
Answer created in January 2024.
Q: My vascular surgeon performed a dialysis circuit open revision and had to remove subcutaneous fat during the procedure. He said this was a more complex procedure than usual, so is there another code to use besides 36832?
A: Removing excess subcutaneous fat is included in the work for 36832, so this is the only appropriate code for an open revision without a thrombectomy.
Answer created in January 2024.
Q: A patient arrived at the clinic as it was closing and told to go to the Emergency Department and physician would meet them there. Does this qualify as an ED visit in this case (99282-99285)?
A: No. If a patient is seen in the emergency department for the convenience of a physician or other qualified health care professional and not out of medical necessity, use office or other outpatient services codes (99202-99215).
Answer created in December 2023.
Q: I don’t see Time listed for codes 99282-99285; can Time be used with these codes?
A: Time is not a descriptive component for the emergency department levels of E/M services because emergency department services are typically provided on a variable intensity basis, often involving multiple encounters with several patients over an extended period of time.
Answer created in November 2023.
Q: A neurosurgeon asked my vascular surgeon to perform the exposure for an anterior spine procedure. Does he report an exploratory lap his work?
A: No. Providing the exposure for a neurosurgeon for an anterior spine procedure is co-surgery, since code 22558 Arthrodesis, anterior interbody technique includes both the exposure/approach and the work on the spine. Both surgeons append the co-surgery modifier 62 to code 22558.
Answer created in October 2023.
Q: I’m a vascular 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?
A: The AMA published clarification on wound vac billing in the October 2021 CPT Assistant. Negative pressure wound therapy (97605-97606) is considered billable for both open and closed wounds. However, that does not mean that payors will reimburse separately for the service, so use caution and track results.
Answer created in April 2023.
Q: We are confused about the difference between modifier 52 and 53. What is the difference?
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?
A: 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.
Answer created in April 2023.
Q: Our vascular surgeon did a single intervention on a lesion that was at the juncture of the femoral/popliteal and tibial/peritoneal territories. Can we charge for two interventions?
A: Lesions that extend across the margins of one vessel vascular territory into another, but can be treated with a single therapy are reported with a single intervention code.
Answer created in April 2023.
This Non-CME Activity is supported through an educational grant provided by CVRx.
The Society for Vascular Surgery joined with the American Medical Association (AMA) and 132 organizations – representing 900,000 physicians and tens of millions of Medicare patients – in a March 15 letter to congressional leaders, telling them that a full inflation-based update