Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

Click here for more sample CPC practice exam questions and answers with full rationale

Practice Exam

CPC Practice Exam and Study Guide Package

Practice Exam

What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

CPC Exam Review Video

Laureen shows you her proprietary “Bubbling and Highlighting Technique”

Download your Free copy of my "Medical Coding From Home Ebook" at the top right corner of this page

Practice Exam

2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

Click here for more sample CPC practice exam questions and answers with full rationale

Nerve Conduction Studies- counting nerves

We’ve had some disagreements about which nerves can be counted and have been told different answers. AANEM told us you can count median to second and median to fourth separate. However, CMS has told us only nerves listed with a letter (A,B,C, etc.) in Appendix J in the CPT book can be counted. The nerves under these headings with a numeral in front of them can’t be counted.

I also read an article from AHIMA that seems to agree with CMS, "CPT Appendix J lists the nerves that can be tested and coded under nerve conduction study codes. The branches of each nerve are also listed, but the unit of service is limited to the nerve and not the branches." https://newsletters.ahima.org/newsle…onduction.html

Does anyone know which is correct so we can put an end to this debate?

Medical Billing and Coding Forum

Genicular Nerve Block – CPT 64450

This injection is a little confusing for me, I know it’s per nerve or branch. But I keep getting a little stuck on this one. My doctors note reads: I identified the right lateral superior genicular nerve branch at the junction of the lateral femoral shaft and lateral condyle; the right medial superior genicular nerve branch, at the junction of the medial femoral shaft and medial condyle; and the right medial inferior genicular branch, at the junction of the medial tibial shaft and condyle. Local anesthetic administration was performed using 2mL of lidocaine 1% at each location. Then using a 22-gauge spinal needle was directed to each end point identified above, confirming proper positioning under fluoroscopy in AP view. After negative aspiration, we injected consisting of 1.5mL of 0.25% bupivicaine and 10mg of Depo-Medrol and each branch of the genicular nerve.

I know 64450 is usually 1 UOS since it’s per nerve or branch My doctor wants to bill 3 UOS.

Any input would be helpful.

Medical Billing and Coding Forum

64772 – Transection or avulsion of other spinal nerve, extradural

Hello,

I work in a pain management practice and one of our providers is being trained to perform a endoscopic rhizotomy. There are not many recourses out there for coding this procedure. Unfortunately, I do not have a description of procedure yet. My provider states this is not a percutaneous approach, that an incision is made through the layers of the skin to accommodate the scope; he then will have direct visualization of the location of the rhizotomy. The procedure representative is telling my physician that CPT code 64772 would be appropriate. I have found a couple of payer policies that state to bill an endoscopic rhizotomy with CPT code 64999 or they deem it experimental all together. I am hesitant, would this approach my provider is describing qualify as MIS as he states his approach is not percutaneous. If it does, then could an open procedure code be used even though it is not in the endoscopic section?

Thank you for your advice.
Sharon

Medical Billing and Coding Forum

ASC – Post Op Nerve Block billing

We have been billing separately nerve blocks for surgical procedures using the following guidelines:

1. Separate procedure from surgery
2. separate area then surgery
3. done by a different physician
4. different specialty fro the surgeon
5. separate procedure note
6. separate anesthesia from surgery
7. billed on separate claim form
8. add modifier 59 and list ICD-10 G89.18 first for DX codes

I am not getting push back from our coding company stating that it is CCI edits and you cannot unbundle or bill separately.

Even though AMA guidelines and ASA state you can unbundle and bill just not to Medicare.

Thought – comments

Medical Billing and Coding Forum

Third Occipital Nerve Block and Ablations

I’m just curious how many people have had issues with providers and TON(third occipital nerve) blocks/ablations.

I’ve found lots of documentation to support using 64490/64633 for the blocks and ablations that take place between the c2-c3 spine. My providers want to use the peripheral codes 64450/64640 – I’m basically at a stand off with my providers at this point, understanding their point but not feeling comfortable changing my coding based solely on their demands, it’s creating an issue.

Any help or resources would be helpful!

Thank you!

Medical Billing and Coding Forum

Spinal accessory nerve to suprascapular and partial radial to axillary nerve transfer

Hello,

I am new to ortho coding. I am trying to find the cpt codes for nerve transfers.

I came up with:

Spinal accessory nerve to suprascapular transfer 64713

Right partial radial to axillary nerve transfer 64999

I cannot find a code to compare the unlisted code to.

I would appreciate all the help. Here is the op-report. Thank you

The patient was identified in the preoperative holding area. We reviewed the operative indications, operative plan and recovery. The right shoulder was marked as the operative site and confirmed with the patient. He was then brought to the operating room. He was placed in the prone position. All bony prominences were well padded. Preoperative antibiotics were given per standard protocol. The right shoulder girdle and upper extremity was then prepped and draped in the normal sterile fashion.
A timeout was performed per standard protocol, identifying the patient, the procedure and the operative site. All personnel were in agreement and there were no discrepancies identified.
A transverse incision was made over the superior aspect of the scapula, beginning medial to the superior angle and eventually extending over the acromion. The incision was taken through skin, subcutaneous tissue and fascia down to the trapezius muscle. The fibers of the trapezius were split transversely to identify the spinal accessory nerve. Once we identified the nerve, we used a nerve stimulator to confirm its identity and its function. We carried our dissection laterally to identify the suprascapular nerve. We had difficulty identifying the suprascapular nerve. Proximally, we identified a section of the nerve, proximal to the notch, that appeared damaged. We carried our dissection distally to the acromion and the spinoglenoid notch. Unfortunately, the nerve was not identified in the notch despite wide exposure, suggesting that perhaps the nerve was avulsed distally, with the spinoglenoid notch serving as a second tethering point.
*
We decided at this point to revisit the suprascapular nerve at a later time and instead to continue with the partial radial nerve to axillary transfer. The incision was extended longitudinally over the posterior aspect of the arm. The incision was taken through the skin, subcutaneous tissue and fascia down to the triceps. The radial nerve was identified in the triangular space. We identified its branches, and used a nerve stimulator to evaluate the function of each branch. We selected the branch that provided only elbow extension as our donor nerve; another branch that provided wrist extension was preserved. We then carried our dissection proximally to the quadrangular space to identify the axillary nerve. We isolated the anterior motor branch. The donor radial nerve was divided as distal as possible, and the axillary nerve was divided as proximal as possible. The microscope was then brought into the operating field. The nerve ends were prepared and coapted under the microscope using 8-0 Nylon sutures. The repair was reinforced with fibrin glue (Eviseal).
*
We turned our attention back to the suprascapular nerve. Again, we found that the proximal portion of the nerve appeared unhealthy, and distally it was absent from the spinoglenoid notch. As such, a spinal accessory to suprascapular nerve transfer would be nonfunctional, and we abandoned this second nerve transfer, deciding it was best to preserve trapezius function as it was one of the few stabilizing muscles remaining around his shoulder.

Medical Billing and Coding Forum