When Descriptor Says 'Each,' Say It Twice
Question: The physician excised a Morton neuroma bilaterally from the second interspace. Should I report 28080 twice, and do I need modifiers -T6 and -T1, or modifier -59?
Colorado Subscriber
Answer: If the physician excised one Morton's neuroma, you should only report 28080 (Excision, interdigital [Morton] neuroma, single, each) once. If she excised two, report it twice.
According to CPT, laterality is not a factor when reporting 28080 because the code can apply to multiple areas of the foot. For this reason, you don't need to append either modifier -T6 (Right foot, second digit) or -T1 (Left foot, second digit). But you should append modifier -50 (Bilateral procedure) to show that the physician performed the procedure on both sides.
Also, because the description for 28080 specifies "each," you don't need to append modifier -59 (Distinct procedural service) to the second code if you report 28080 twice.
Make Do With Physician-Oriented 90781
Question: We had an emergency department patient who received normal saline through intravenous infusion for almost 11 hours. He spent the whole time in the ED, getting stabilized and prepared for admission. Usually, we'd assign 90780 and 90781, but 90781 is only appropriate for up to eight additional hours, which leaves us with two hours of unreported infusion. How should I handle this?
Connecticut Subscriber
Answer: Infusion CPT codes were originally intended for physician office use, where even prolonged infusion services would rarely extend beyond an eight-hour day. In the facility setting, coders usually report the actual number of additional hours (90781), even though the CPT definition doesn't correspond.
Keep in mind that you should report codes 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) and +90781 (... each additional hour, up to eight hours) only for non-Medicare insurers as applicable. Medicare still requires HCPCS Q0081 (Infusion therapy, using other than chemotherapeutic drugs, per visit) for infusion therapy - with a quantity of "1" per visit - regardless of the number of hours of infusion.
Report Intended Procedure - Not Completed One
Question: The physician was performing a colonoscopy, but when he had introduced the scope 20 cm into the rectum, he encountered an abscess and had to discontinue the procedure. Should I report 45300, since he did complete a proctosigmoidoscopy?
Idaho Subscriber
Answer: No, you shouldn't report 45300 (Proctosigmoid-oscopy, rigid; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) for this procedure, even though the physician's work did meet the criteria for it.
The more appropriate code to report would be 45378 (Colonoscopy, flexible, proximal to splenic fixture; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]), because that is the service the physician intended to provide. To show that the procedure was incomplete, you should append modifier -73 (Discontinued outpatient hospital/ambulatory surgery center procedure prior to administration of anesthesia) or -74 (Discontinued outpatient hospital/ambulatory surgery center procedure after administration of anesthesia).
Your coding should reflect the extent to which the physician performed the intended procedure, and additional diagnosis codes will tell the story of the abscess (and explain why the procedure was incomplete).
NOTE: CORRECTION TO THE ABOVE QUESTION APPEARS IN THE FEBRUARY ISSUE ON PAGE 15 AND BELOW:
The answer advised readers to report an incomplete colonoscopy by appending either modifier -73 (Discontinued outpatient hospital/ambulatory surgery center procedure prior to administration of anesthesia) or -74 (Discontinued outpatient hospital/ambulatory surgery center procedure after administration of anesthesia) to the colonoscopy code.
However, the more complete answer is that CPT and CMS have differing instructions for the coding in this scenario. CMS requires you to assign the code that matches the completed procedure (if one exists), and not to report the code for the intended procedure with a modifier. So if you were billing a government payer, you would report a proctosigmoidoscopy for the example given.
If you're billing a private payer, it may be more appropriate to report the colonoscopy code and append modifier -52 (Reduced services), because the most common type of anesthesia with colonoscopies is conscious sedation - which is not specified in the descriptions for modifiers -73 and -74. Use of modifier -52 also holds true if conscious sedation was used and no CPT code exists to accurately describe the procedure that was accomplished during the session.
We regret the error.
