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Q: Would this be coded to CPT 19307 LT 1. Left mastectomy with sentinel lymph node biopsy, frozen section result. 2. Left axillary lymph node dissection. The axilla was addressed. First, a small incision was made over the radioactive lymph node and taken down through the skin and subcutaneous tissue and clavipectoral fascia. The lymph node was identified and given to the scrub technician. At this point, it was sent for frozen section analysis. However, it did look rather large and sclerotic in nature. The mastectomy was undertaken at this point by raising a flap superiorly to the level of the clavicle, extending from the sternum to the axilla, with Harmonic scalpel, and inferiorly, a flap was similarly raised, dissecting the breast from the subcutaneous tissues down to the level of the junction of the rectus muscle and chest wall. The breast was reflected from medial to lateral with the Harmonic scalpel, using it control small bleeders. Given the size and nature and aggressiveness of the tumor, it was elected to do a level I dissection, nonetheless, in spite of a negative node analysis on frozen section, and this was undertaken well below the axillary vein. This axillary pad was given to the scrub technician.
A: From what I can determine, you are correct here.
Dawson Ballard, Jr., CPC, CCS-P
Q: When the a family medicine doctor employs RT, is it appropriate to bill under the doctor with codes as 94200 TC59, 94375-59, 94200-26, 94375-26?
A: I am not sure why you have the code 94200 mentioned twice once with modifier TC-59 and once with modifier 26. It sounds like your clinic/office owns the equipment so you would be able to bill code 94200 without a modifier and that would indicate you are billing for the complete service. The same goes for code 94375. Also codes 94200 and 94375 can be billed together; there are not CCI edits, so modifier 59 on code 94200 is not needed.
These services can be billed under the physician when done by an RT employed by the physician.
Please see the link below for more information regarding pulmonary coding.
http://www.rcjournal.com/contents/08.03/08.03.0786.pdf
Lisa L. Withers, RHIT, CCS
Q: If the doctor removed a single chamber pacemaker pulse generator, left a previously implanted right ventricular electrode in place, implanted a new atrial electrode and connected both electrodes to a new dual chamber pacemaker pulse generator, what codes would be billable? 33208, 33233, 33214, 33217?
A: You would only use code 33214 for converting a single chamber pacemaker to a dual chamber pacemaker. The CPT Manual description for 33214 says this code "includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead and insertion of new pulse generator."
Also, there is a CPT Assistant article from Fall 1994 that says, "When a single chamber system is converted to a dual chamber system, only one code is reported (33214), because this code describes the entire conversion (upgrade) of a single chamber system to a dual chamber system."
Amy Hodges, CPC, CPC-I
Q: My question is related to coding an infusion or hydration in an emergency department. If the IV is started outside the hospital, say by the EMT on the way to the ED, would the ED still charge for the initial hydration 96360 and any additional hours of hydration, 96361, or would they just report the add-on code 96361?
A: Yes, it is appropriate to charge for an initial hydration even if it is started by EMS. According to the Medicare Claims Processing Manual, IOM 100-4, facilities may bill the infusion code for non-chemotherapeutics, whether or not the facility initiated the infusion if all requirements for the infusion service are met. There is no significant potential for overpayment when the infusion is not initiated in the facility. I think the tricky part with this one is if you are charging hydration, it must run > 30 minutes (or at least 31 minutes) before one can charge for it all. I would recommend incorporating into a policy what you will be using for a start time (i.e., time patient reaches a bed in their ED or time of triage, etc.) in order to calculate all of the hydration hours. 96361 is an add on code so 96360 or some other initial drug administration code must be reported. When reporting 96361 for multiple hours of hydration, you must be greater than 30 minutes into the subsequent hour.
Kim Heibel, CPC
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