Physician billed a 61322 – CPT® Code in category: (Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma)
Shortly thereafter the patient developed an intracranial bleed requiring a return to the OR the same day for a 61313 – CPT® Code in category: (Craniectomy or craniotomy for evacuation of hematoma, supratentorial)
As per coding guidelines these 2 cpt codes cannot be billed together on the same day. Considering the circumstances I advised to bill the charge with a -78 modifier unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the post-operative period and appeal if need be.
Ive been advised to bill 61322 twice with the 76 modifier (Repeat Procedure by Same Physician is used to indicate that a procedure or service was repeated in a separate session on the same day by the same physician) which Im not comfortable in using because the 2nd OP note does not support this code. It does support the bleed CPT 61313.
I’d like others opinions.
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The adage to ‘always report the most specifc CPT code’ could ensnare your estrogen receptor (ER) and progesterone receptor (PR) coding for breast cases. Here our experts help you sort out the difference between specific analyte and specific method to ensure you select the right code every time.
Reserve 84233 and 84234 for assays
If you are searching for specific codes when a surgical pathology report references estrogen and/or progesterone receptor testing, you should not miss 84233 and 84234. However are those always the correct choice?
The 84233 and 84234 definitions create a confusion for medical coders reporting ER/PR tests. The question is whether you must report 84233/84234 as the definitions specify ER/PR, or if you can in its place report a generic immunohistochemistry code such as 88342 for certain ER/PR testing.
Codes 84233 and 84234 describe laboratory tests for estrogen and progesterone receptors that use a biochemical ligand-binding assay method like dextran-coated charcoal assay. However most labs evaluate ER/PR using immunohistochemistry as clinical studies have consistently shown the superiority of immunohistochemistry over biochemical assay methods for ER/PR testing.
Watch out for immunohistochemistry (IHC)
When the lab method involves immunohistochemistry for tissue specimens like evaluating breast tumors for ER and PR status, you should look to the following codes to describe the service: 88342, 88360, 88361.
Although these code definitions are ‘generic’ in the sense that they do not specifically identify estrogen or progesterone receptors, you should report them for an ER or PR (or any other) immunohistochemistry antibody strain.
Differentiate qualitative/quantitative codes
Choosing among 88342, 88360, or 88361 calls for knowing whether the immunohistochemistry analysis is qualitative or quantitative and whether quantification uses computer-assisted technology or “manual” counting, including visual approximation. You might choose to go for any of these three codes for ER, PR, Her- 2/neu, Ki-67, or any of various other IHC analyses
You should report one unit of the right code for each antibody stain, irrespective of which antibody you are coding.
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