Pediatric cataract surgery. Alternatively, some state LCDs say

that a mature cataract requiring dye for visualization of capsulorrhexis does support CPT 66982. Keep in mind, if trypan blue is over-

utilized as part of the physician’s stan- dard of care for the majority of cataract cases, then it may not be deemed medi- cally necessary or warrant the complex code assignment.

When coding glaucoma shunts, pay attention to the approach, not just the type of shunt used. XEN Gel stents are typically associated with 0449T, with physicians using an ab interno approach to insert the stent through the cornea into the angle and then through the sclera where it emerges underneath the conjunctiva. The CPT code, how- ever, describes the procedure, not the device. If a XEN Gel stent is inserted in the opposite direction, through the con- junctiva first, then through the sclera and then through the angle into the anterior chamber, this is considered an external approach. Code it with 66183. Surgeons have begun using the Omni glaucoma treatment system to dilate Schlemm’s canal. This is often documented as the dilation and a goniot- omy. Even though there are no National Correct Coding Initiative (NCCI) edits between 66174 and 65820, AMA states to code only 66174 because the goniot- omy is incidental and does not involve any additional physician work.

Orthopedics According to the American Acad- emy of Orthopedic Surgeons (AAOS Bulletin, April 2005), 29879 for knee arthroscopy

with abrasion arthro-

plasty, drilling or microfracture can be reported per compartment. How- ever, Medicare allows the reporting of 29879 only once per knee per session. Know your carrier guidelines so you do not miss potential revenue. 29875, for knee arthroscopy with limited synovectomy, has a separate pro- cedure designation. This means it should

Considering the complex and confusing nature of coding, ASCs should undertake routine coding audits that review a meaningful number of codes submitted to payers and then compare those codes against what is supported in the documentation.”

—Mandeara Frye Surgical Notes

never be reported with other knee arthros- copy codes. Even when performed in a separate compartment from a meniscec- tomy, do not code 29875 unless it is the only procedure performed.

Concerning coding biceps tenot- omy and tenodesis, know the dif- ference between these terms. Tenot- omy concerns the cutting of a tendon while tenodesis is suturing a tendon to bone. These common biceps pro- cedures are performed arthroscopi- cally. Biceps tenodesis is 29828, but there is no specific code for the biceps tenotomy. AMA directs coders to use a debridement code (29822/29823) for the biceps tenotomy, depending on the extent of the work. Something to keep in mind: If an extensive debridement is performed in another area of the shoul- der, include the tenotomy.

Pain Management

When coding injections, pay attention to the approach. Is it a transforaminal or an epidural? Review the documentation to determine the entry point of the nee- dle. Some techniques involve placing a needle into the epidural space, then advancing a catheter to exit the fora- men. Although the foramen is involved, this is really an epidural (62321/62323) because of the approach into the epi- dural space. Transforaminal injections

(64479-64484) require the needle to be advanced across the foramen. For continuous infusion via cathe-

ter, the catheter must remain in place for more than a single day. According to the May 2017 CPT Assistant, “If the cathe- ter is left in place to deliver substance(s) over a prolonged period (i.e., more than a single calendar day) either continuously or via intermittent bolus, use 62324, 62325, 62326, 62327, as appropriate.” If your surgeon fails to state that the catheter was removed, send a query. The documentation also should sup- port securing the catheter for it to be considered indwelling. For lumbar sympathetic blocks

(64520), code per level, according to the December 2010 CPT Assistant. Review documentation to see if the injection is being performed at the L1, L2 and/or L3 levels and code each sep- arately. Note: 64520 has a medically unlikely edit (MUE) of “1,” so know your carrier guidelines. Finally, know your payer’s frequency limitations for injections to avoid deni- als. Medicare limits the number of injec- tions per year. Now, many commercial carriers are adopting similar limits. Ver- ify such limits to avoid denials.

Catching and Correcting Coding Mistakes Considering the complex and confus- ing nature of coding, ASCs should undertake routine coding audits that review a meaningful number of codes submitted to payers and then compare those codes against what is supported in the documentation. It also is wise to seek out an external vendor to perform such audits. An external auditor—spe- cifically one with ASC experience— can perform an objective examination that will help identify coding errors that can leave substantial amounts of money on the table.

Mandeara Frye is director of coding for Surgical Notes in Dallas, Texas. Write her at


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