This page addresses follow-up questions and additional information pertinent to our webinar
Procedure Coding Updates for Facility.
** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.
A: Yes, the tendon transfer codes reported with 25312 and 26483 are typically used for injuries so it was not necessary for the CPT panel to survey these codes when making the changes to 25447 and 25448.
A: Code 60660 would be reported for the ablation performed on the isthmus and add on code 60661 would be reported for the ablation on the additional lobe.
A: Correct, for laparoscopic procedures there isn’t an age differentiation so 49650 and 49651 which represent a repair of an initial or recurrent repair. It would not be appropriate to use the unlisted but rather use each one of these for any age group. If this is a neonate, then the appropriate modifiers can be used.
Q: To use an intermediate repair code, must the superficial or non-muscle fascia be closed in addition to the skin, and do the layers closed need to be specifically named in the documentation? We often see, “the defect was closed in layers using absorbable sutures for deep subcutaneous tissue and 2-0 vicryl for the skin” – Is this acceptable to code for intermediate repair, or is it considered a simple repair?
A: Intermediate closure indeed does require closing a layer of tissue in between skin and deep muscle fascia so that would need to be included in the description of work. It has to be a little bit more than just describing that different layers were closed, but instead actually singling out what the layers were that was closed and what was described is pretty close to being able to describe that, but it just needs to be spelled out that way.
Q: What CPT code is used to report a resection of a right vagus nerve schwannoma? Can 64792 be used or is this only used for peripheral. We realize 64471 is for transection of the cranial nerve, but this was a major neck dissection so doesn’t seem to fit the intent of the procedure.
A: The biggest nerve is the cranial nerve but that also becomes a peripheral nerve and is an example of a complex peripheral nerve. The coverings of the nerve in the central nervous system are surrounded by oligodendrocytes and Schwann cells are actually surrounding the peripheral nerves. So, by definition, Schwannoma would be reported as a peripheral nerve, so 64790 or 64792 depending on if it had a malignant transformation. The 64771 actually isn’t a tubal resection, either so that’s just a transection or avulsion of the cranial nerve so you would not be using that code.
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Jennifer Cayce, RHIT, CCS, CCS-P, CPC, Risk Adjustment Coding (RAC) Microcredential
Director of Coding Quality & Compliance
As a Director of Coding Quality & Compliance, Jennifer brings over 20 years of health information management, auditing, and coding experience to Haugen Consulting Group.
During her career, Jennifer has served as an inpatient and outpatient medical coder, lead coder, coding supervisor, auditor, and has developed training materials for multiple areas of HIM. Jennifer was integral in the development of web-based HIM education for coders, providers, clinical documentation improvement specialists, case managers, and patient access professionals.
During her time as a coding supervisor, Jennifer experienced a high success rate when appealing RAC and other external audit findings.
At the Haugen Consulting Group, Jennifer coordinates and leads the facility audit team and provides coding expertise and support to clients.
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