Amazing tips for CPT code 62320, 62321, 62322, 62323 in 2017


There are lot of changes in cpt codes in 2017. For example, the old codes for screening and diagnostic mammogram have been deleted and the new CPT code 77065, 77066and 77067 have been added. Also these new codes are bundled codes which includes the Computer aided detection (CAD). Similarly, we have new CPT codes 62320, 62321, 62322, 62323, 62324, 62325, 62326 and 62327 for coding Spinal injection procedures. Earlier we used procedure codes 62310, 62311, 62318, 62319 for coding spinal injection exam till 2016. But from 2017 we will be using new CPT codes for these exams. Let us check when these CPT codes should be used for these exams.

Coding tips for CPT code 62320 and 62321


If you read the code description, the first basic difference between CPT code 62320 and 62321 is the used of imaging guidance. So, when a spinal steroid injection is performed percutaneously into interlaminar epidural or subarachnoid, cervical or thoracic region, and if it is performed without imaging guidance report CPT code 62320. But when the same exam is performed using imaging guidance like fluoroscopy or CT, use CPT code 62321. Below is the full code description for both these procedure codes.

62320 - Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance

62321- Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (ie, fluoroscopy or CT)

Coding tips for CPT codes 62322 and 62323


These CPT codes should be reported only when the spinal steroid injection is performed in the interlaminar epidural or subarachnoid, lumbar or lumbosacral region. Here also, use CPT code 62322 when the exam is performed without imaging guidance and for exam with imaging guidance use CPT code 62323. Below is the full code description for both the procedures codes.

62322 - Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance

62323 - Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT)


Sample coded Report for CPT code 62320, 62321, 62322 & 62323


RAD/DG NONSEL EPI INJ LUM/SAC EA
CLINICAL DATA:  Lumbosacral spondylosis without myelopathy. RIGHT
leg radicular symptoms.

FLUOROSCOPY TIME:  13 seconds corresponding to a dose of 10.5 mGy.

PROCEDURE:
The procedure, risks, benefits, and alternatives were explained to
the patient. Questions regarding the procedure were encouraged and
answered. The patient understands and consents to the procedure.
Time-out performed.

LUMBAR EPIDURAL INJECTION:

An interlaminar approach was performed on RIGHT at L5-S1. The
overlying skin was cleansed and anesthetized. A 20 gauge Crawford
epidural needle was advanced using loss-of-resistance technique.

DIAGNOSTIC EPIDURAL INJECTION:

Injection of Omnipaque 180 shows a good epidural pattern with spread
above and below the level of needle placement, primarily on the
RIGHT; no vascular opacification is seen.

THERAPEUTIC EPIDURAL INJECTION:

120.0 Mg of Depo-Medrol mixed with 2 mL 1% lidocaine were instilled.
The procedure was well-tolerated, and the patient was discharged
thirty minutes following the injection in good condition.

COMPLICATIONS:
None.

IMPRESSION:
Technically successful epidural injection on the RIGHT L5-S1 # 1.

CPT code – 62323

Since the above epidural steroid injection exam is performed in the lumbosacral region percutaneously in the presence of fluoroscopic guidance, CPT code 62323 has been reported for this exam.


Superb coding tips for Hydration CPT code 96360 & 96361


In Emergency department (ED) coding, use of hydration codes is required in facility coding. CPT code 96360 and 96361 are used in coding hydration infusion. In this procedure a physician or an assistant under direct physician supervision infuses a hydration solution such as prepackaged fluid and electrolytes for 31 minutes to one hour through an intravenous catheter inserted by needle into a patient’s vein or by infusion through an existing indwelling intravascular access catheter or port. For initial 31 minutes to 1-hour hydration, we should report CPT code 96360 and for each additional hour, use CPT code 96361.

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Description of CPT code 96360 and 96361


The hydration CPT codes should be used following the ED coding guidelines. The ED coders should follow the hierarchy      96365>96374>96372>96360. The CPT codes for IV infusion, IV pushes, IV injection and hydration should be based on this hierarchy. Below is the full code description for CPT code 96360 and 96361.

96360- Intravenous infusion, hydration; initial, 31 minutes to 1 hour

96361- each additional hour (list separately in addition to code for primary procedure)

Do and Don’t with CPT code 96360 and 96361


Do not report CPT code 96360 when performed as a concurrent infusion service

Do not report intravenous infusion for hydration of 30 minutes of less

Always use CPT code 96361 along with or in conjunction with CPT code 96360

Report CPT code 96361 for hydration infusion intervals of greater than 30 minutes beyond 1 hour increments.

Use CPT code 96361 to report hydration if provided as a secondary or subsequent service after the different initial service like CPT code 96360, 96365, 96374, 96409, 96413 when administer through same IV access.


The CPT code 96360 or 96361 are not intended to be reported by the physician or other qualified healthcare professional in the facility setting.

When to use Modifier 47, 50 and 51


Modifiers are very important in medical coding. We have already discussed previously about 25 and 27 modifier. It is quite complicated to choose the correct modifier and use them with CPT code. Today again we will discuss about modifier 47, 50 and 51.  These modifiers are very common to use during surgery coding. Also, if you want to clear CPC exam or CCS exam, you should be perfect in using modifiers with procedure codes. Let us learn each modifier one by one.
When to use Modifier 47, 50 and 51


Read also: Coding tips for Thoracentesis and Paracentesis

When to use Modifier -47

Modifier -47 is used to report a surgical procedure in which the surgeon administers anesthesia (regional or general anesthesia) in addition to performing the surgery. Modifier 47 should not be used when a local anesthesia is used. The payment through a third party payer for modifier 47 should be based on the time spent administering the anesthesia. The surgery CPT code will be reported with modifier 47 by the surgeon who is acting as an anesthelogist. Modifier 47 should always be used with surgery CPT codes and never with the anesthesia codes.

When to use Modifier -50


Modifier -50 is used if the same procedure is performed on a mirror-image part of the body, using the same CPT procedure code to indicate a bilateral procedure. There are different methods the payer wants bilateral procedures to be submitted on the claim form.  Modifier 50 is the coding practice of choice when reporting bilateral procedures. The Medicare bilateral indicator is 1 or 3. 50 modifier is used when an identical procedure performed on both sides of the paired organ. Do not use RT or LT modifier in place of 50 modifier. RT and LT modifier should be used only when a procedure is performed on one side of the paired organ.
The physician performs a surgical sinus endoscopy with total ethmoidectomy, 31255, on the left and right ethmoid sinuses (bilateral).
1.       Using modifier -50, the service would usually be reported as 31255 and 31255-50.
2.      Using the Medicare modifiers for sides (-LT, left side and -RT, right side), the service would be reported as 31255-LT and 31255-RT.
3.      Using the one-line format, the service would be reported as 31255-50.
The most specific method of reporting is the second format, as it indicates not only the number of procedures, but also the side of the body.

When to use Modifier -51

Multiple Procedures

Modifier -51 is indicated when multiple procedures are performed at the same session by the same provider. This modifier should not be appended to designated add-on codes. Assign modifier -51 when multiple procedures, other than the E/M services, are performed on the same day or at the same session by the same provider. When reporting multiple surgeries, the primary procedure (procedure with the highest relative value unit) should be listed first on the claim. Use of modifier 51 should be done carefully because many procedure or CPT codes include many different procedures bundled together in one code. It would be incorrect to report services separately if they are included (bundled) in the description for a code. Unbundling is assigning multiple codes when one code would fully describe the service or procedure. The assigning of multiple codes in such a case results in increased reimbursement and is considered fraud by a third-party payer.
However, if one code does not describe all of the procedures performed, and the secondary procedure is not considered a minor procedure that is incidental to the major procedure (and therefore bundled into the major procedure), each additional procedure may be reported by using modifier -51.


Multiple procedures are reported in the following three significant circumstances:

·         The same operation is performed on different sites.

For example:  When an excision is 1 cm benign lesion done for patient of forearm and at the same time an excision of 2 cm benign lesion is done in the neck region. In such a case we will be coding two procedure codes for excision for forearm and neck with a modifier 51 to the second CPT code.
·         Multiple operations are performed at the same operative session.
There is multiple procedure performed at the same operative session. Always code the primary procedure which is more extensive or major procedure and then followed by the minor procedures of decreasing order of complexity with 51 modifier. The primary procedure should be paid full, second procedure during the same session should be paid 50% and the third procedure should be paid 25% of the fee, if there are 3 procedures performed at the same time.
·         The procedure is performed multiple times

Multiple procedures are also reported when the same procedure code is used to identify a  service performed more than once during a single operative session. There are two ways to report procedures performed multiple times, depending on the requirements of the third-party payer.

Coding Shot

When to use New Moderate Conscious Sedation CPT codes in 2017

We have new Cpt codes for moderate conscious sedation in 2017. Yes, old codes for moderate sedation will be deleted from 2017 and we will be using new set of codes for these services. We have already learned about the new CPT codes of 2017 for stent placement.  Also, there are new CPT codes for AV fistula or graft access in 2017 and for the interventional procedure in dialysis circuit. So, let us first checkout the new codes in moderate sedation section and their description in detail.

When to use New Moderate Conscious Sedation CPT codes in 2017


New CPT code for Moderate Sedation


There are 6 new CPT codes for moderate sedation in 2017. These CPT codes are used to report moderate sedation in 15 minutes’ increments. Below is the code description of the new CPT codes in 2017 for moderate sedation.

99151 –   Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient younger than 5 years of age

99152 Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older

+99153 Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; each additional 15 minutes intraservice time (List separately in addition to code for primary service)

99155Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger than 5 years of age

99156 Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient age 5 years or older

+99157 Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; each additional 15 minutes intraservice time (List separately in addition to code for primary service)


When to use CPT code 99151 and 99152


When same physician performing the diagnostic or therapeutic procedure also performs conscious sedation, we can report CPT code 99151 and 99152. If you read the description of these two CPT codes, you will understand the age of the patient will help you to code these procedures. If the patient is younger than 5 years, use CPT code 99151 and when the patient is older than 5 years, use CPT code 99152. Both these CPT codes should not be used together. Also, presence of the independent trained observer to monitor the level of patient consciousness is mandatory for coding CPT code 99151 and 99152. These CPT codes are the initial service codes for first 15 minutes for moderate sedation. For each additional 15 minutes we have separate add-on code, +99153.

When to use CPT code 99155 and 99156


When the moderate sedation is given by physician other than the physician performing the diagnostic and therapeutic services, then we can use CPT code 99155 and 99156. Also, these CPT codes are to be used for initial 15 minutes of services. For patient younger than 5 years use CPT code 99155 and older than 5 years use CPT code 99156. For each additional 15 minutes, use add-on CPT code +99157.







New CPT code changes in 2017 for Diagnostic and Screening mammogram.

Radiology facility has some very important CPT codes in 2017. Yes, this time we have some CPT codes introduced in radiology section. There are no changes in ultrasound, MRI, CT section. But, the screening and diagnostic mammogram has new CPT codes in 2017. Old mammogram codes will not be used from 2017. So, let us learn more about the new CPT codes changes of 2017 for medical coders.

New CPT code changes in 2017 for Diagnostic and Screening mammogram.



New CPT codes in 2017


Major changes in CPT codes has happened in surgery section. If you are an Interventional radiology coder (IVR) you will have to really learn many new codes in 2017. From 2016, the old CPT codes for angioplasty except for lower extremity are deleted. There are new CPTcodes for angioplasty in 2017 for IVR coders. Also, the radiological Supervision and interpretation (RS&I) of angioplasty CPT codes are deleted. The new CPT codes will bundle all the RS&I. As I have mentioned, there are new CPT codes for diagnostic and screening mammogram, so let us check out them.

New CPT code description for Diagnostic and Screening Mammogram


The new CPT codes are has similar code description like old codes. Only, the major difference is the inclusion of CAD (computer-aided detection) code with the mammogram CPT code. So, the old mammogram and CAD codes will get deleted from 2017. The new CPT codes description of mammogram is given below.

77065 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral

77066 Bilateral

77067 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed

Continue using HCPCS G codes for diagnostic and Screening Mammogram for Medicare patients. You can use G0202, G0204 and G0206 in 2017 as well for mammogram.

Do and Don’t with Diagnostic and Screening Mammogram CPT code


Do not search or use an CAD code with mammogram CPT codes, it is included in the mammogram procedure code.

Use 52 modifier while coding for screening mammogram unilateral (77067-52). Since, we have only bilateral CPT code for screening mammogram, we have to use 52 modifier with CPT code for unilateral exam for reduced services.


Do not use diagnostic and screening mammogram CPT codes together. It is not possible to perform both exam together.