Coding Notes

These Coding Notes are not posted to my website as codes reported must match YOUR documentation. CODING NOTES: Venous – blood returns toward heart. Arterial – blood from heart to organ system. Peripheral – outside of nervous system IV start without anesthesia services (requires the skill of a physician or other qualified healthcare professional) 36400 – venipuncture (femoral or jugular vein) older than age 3 36410 – venipuncture younger than age 3 36000 – peripheral vein (introduction of needle or intracatheter). Not bundled with USG. 41019 – placement of needles, catheters, or other device(s) into the head and/or neck region. Not bundled with USG. Prostate Brachytherapy 55875 (00400 - 3) Trans-perineal placement 55876 (00400 - 3) integumentary or (00902 - 5) anorectal Any approach, placement of interstitial device (in between) prostate 55860 (00860 - 6) Exposure of prostate, any approach, for insertion of radioactive substance. (This may include a retropubic {lower abdomen} or perineal {between anus and genital area} incision. TAVR – Transcatheter Aortic Valve Replacement (active clinical trials from 2004 – 2019 {symptomatic patients}) Asymptomatic patients (underlying condition, not experiencing noticeable symptoms) may still require a Q0 modifier). Aka TAVI – Transcatheter Aortic Valve Implantation 1/7/13 – Transmittal 2737 TAVR NCD 9/24/12 – Transmittal 2552 TAVR NCD 6/21/19 – Transmittal 217 TAVR NCD Pending latest transmittal (coverage and single-operator allowance) 0318T (Temporary code) – 33366 (00560) TAVR, transapical (tip of heart) exposure (eg, left thoracotomy) 0256T (Temporary code) – 33361- 33364) 33361 (00560 - 15) TAVR, percutaneous (through the skin with needle puncture) femoral artery approach 33362 (00560 - 15) TAVR, open femoral artery approach 33363 (00560 – 15) TAVR, open axillary artery approach 33364 (00560 - 15) TAVR, open iliac artery approach FEVAR – Fenestrated Endovascular Aortic Repair Temporary codes (0078T, 0079T, 0080T, and +0081T) were deleted effective December 31, 2013 • Visceral Aorta Only (Codes 34841–34844): Used when the fenestrated graft only covers the upper portion of the aorta containing the renal, celiac, or superior mesenteric branches. • Visceral + Infrarenal Aorta (Codes 34845–34848): Used when a larger, combined graft configuration is deployed to repair both the branching upper section and the lower abdominal section of the aorta. All FEVAR codes crosswalk to 01926 – 10 Interstim (urinary control) Temporary codes (0282T, 0283T, and 0284T – intended for subq field stimulation) were deleted effective December 31, 2016 64561 Trial stage (00300 - 5) Percutaneous implant, sacral nerve (includes USG). 64581 Stage I (00630 - 8) Open implant, sacral nerve (transforaminal placement). 64590 Stage II (00400 - 3) or (00300 - 5) integumentary (based on location of generator placement) Insertion or replacement of peripheral, sacral, or gastric neurostimulator. 64595 Revision or removal (00400 - 3) or (00300 - 5) integumentary (based on location of generator removal) Intraperitoneal – stomach, liver, gallbladder, spleen, jejunum and ileum, cecum, appendix, transverse colon, sigmoid colon, pancreas (tail), and first 2 cm and duodenal bulb. In women, includes uterus, fallopian tubes, ovaries. Retroperitoneal – SADPUCKER (Mnemonic) S – Suprarenal (adrenal) glands – sit on top of the kidneys A – Aorta and Inferior Vena Cava (blood vessels running along the back wall of the abdomen) D – Duodenum (first 2 cm of duodenal bulb is intraperitoneal) P – Pancreas (only the tail is intraperitoneal) U – Ureters (tubes that carry urine from kidney to bladder) C – Colon (ascending and descending – transverse and sigmoid are intraperitoneal) * ASA considers procedures on the colon to be upper abdominal unless the work is performed exclusively on the sigmoid colon or rectum. K – Kidneys (located on either side of the spine) E – Esophagus (lower thoracic portion as it passes down through the posterior mediastinum) R – Rectum (final straight portion of the large intestine) Extraperitoneal - encompass every major structure inside the abdominal and pelvic cavities that are outside of the peritoneal sac. History: RVG and ASA did not always have the same codes! 1962 – February ASA notebook has 4 digit codes. 1966 – AMA published CPT, no chapter for anesthesia codes. HIPAA formally aligned the industry by mandating standard code sets on October 16, 2003. Use of propofol required V58.83 or V58.69 (ICD 9) by Novitas and Noridian. These now map to Z51.81 (therapeutic drug monitoring) and Z79.899 (other long term current drug therapy). CDT dental codes D9220 and D9221 were replaced effective January 1, 2016 Replacement Codes: • D9222 covers the first 15 minutes of deep sedation/general anesthesia (without an advanced airway). • D9223 covers each additional 15 minutes of deep sedation/general anesthesia (without an advanced airway).