Medical Coding Guide

Normal native connections exist when the pathway of blood flow follows the expected course through the right and left heart chambers and great vessels (ie, superior vena cava [SVC]/inferior vena cava [IVC] to right atrium, then right ventricle, then pulmonary arteries for the right heart; left atrium to left ventricle, then aorta for the left heart). Examples of congenital heart defects with normal connections would include acyanotic defects such as isolated atrial septal defect, ventricular septal defect, or patent ductus arteriosus. Services including right heart catheterization for congenital cardiac anomalies…

For the CPT 2024 code set, two new Category III codes (0807T, 0808T) were established to report pulmonary tissue ventilation analysis. This article provides an overview of the intent and use of these new codes. Description of code 0807T and 0808T Category III codes  0807T  Pulmonary tissue ventilation analysis using software-based processing of data from separately captured cinefluorograph images; in combination with previously acquired computed tomography (CT) images, including data preparation and transmission, quantification of pulmonary tissue ventilation, data review, interpretation and report (Do not report 0807T in conjunction with…

Basics of Otorhinolaryngologic Services Coding In otorhinolaryngology, auditory processing disorders are characterized by inefficient communication between the ears and the brain resulting in an inability to process the information heard. Special otorhinolaryngologic service codes 92521-92524 are used to report diagnostic services that are not included in an evaluation and management service and that are predominantly performed by speech-language pathologists (SLPs). Because most of the population with auditory processing disorders are children, proper diagnosis is extremely important and allows physicians or other qualified health care professionals (such as an SLP) to…

Basics of CPT code 33276, 33277, 33278, 33279, 33280, 33281, 33287, 33288 For the CPT 2024 code set, eight new codes (33276-33281, 33287, 33288) were established in the Heart and Pericardium Pacemaker or Implantable Defibrillator subsection of the Cardiovascular System section to report insertion, removal, repositioning, and replacement of a phrenic nerve stimulator system and/or its components. Category III codes 0424T-0436T were deleted and new guidelines, headings, and parenthetical notes were included to provide instructions regarding appropriate reporting for these services. In addition, four new codes (93150-93153) were established to…

For the CPT 2024 code set, Category I code 75580 and two parenthetical notes were established to report a noninvasive estimate of coronary fractional flow reserve (FFR) derived from augmentative software analysis of the data set from a coronary computed tomography angiography (CCTA). Category III codes 0501T-0504T and three associated parenthetical notes were deleted to accommodate the new code. This article provides an overview of these changes and additions. Description of Procedure code 75574, 75580  75574          Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material,…

For the CPT 2024 code set, codes 64590 and 64595 were revised. Because both these codes are used to report programming of neurostimulators, similar to codes 95971 and 95972, it is important to know the intent and reporting differences of these four codes. Therefore, the purpose of this article is to highlight the differences and provide instructions regarding reporting codes 64590 and 64595 vs codes 95971 and 95972. Code description of CPT code 64590, 64595, 95971 and 95972  64590    Insertion or replacement of peripheral, sacral, or gastric neurostimulator pulse generator…

Today, I came across a scenario where three modifiers are used together which is very rare. So, I would like to share that scenario which will surely help to use the modifier wisely. Below is the question with the answer as well. Question :An ophthalmologist performs cataract surgery on a patient’s right eye two weeks after performing cataract surgery on the patient’s left eye. The patient has an age-related nuclear cataract. The patient tolerates the procedure well and remains under the surgeon’s care for eight days after the procedure and…

CMS published its HCPCS Quarterly Update in March, which heralded the sum of 94 HCPCS Level II code additions, discontinuations, and definition revisions. The changes became effective April 1. 62 added codes 21 discontinued codes 11 revised codes Below are the Newly added HCPCS codes effective 1st April 2024 A2026 Restrata minimatrix, 5 mg A4271 Integrated lancing and blood sample testing cartridges for home blood glucose monitor, per month A4438 Adhesive clip applied to the skin to secure external electrical nerve stimulator controller, each A4564 Pessary, disposable, any type A4593 Neuromodulation stimulator…

CMS created 2 new service codes describing CHI services that auxiliary personnel, including community health workers (CHWs), may perform incidental to the professional services of a physician or other billing practitioner, under general supervision. The billing practitioner initiates CHI services during an initiating visit where the practitioner identifies unmet SDOH needs that significantly limit their ability to diagnose or treat the patient. The new G codes for CHI:  G0019 – Community health integration services performed by certified or trained auxiliary personnel, including a community health worker, under the direction of…

Begining Jan. 1, 2024, qualified healthcare providers can bill an add-on HCPCS Level II code to report the extra time, effort, and associated practice expense involved with caring for Medicare patients across the continuum of healthcare. G2211     Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition. (Add-on code, list separately in addition…