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Kent J. Moore
Fam Pract Manag. 2004 Oct;11(9):25-26.
You are watching: What is the cpt code for cryotherapy
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A local billing and coding expert told us that only psychiatrists, psychiatric APRNs or those who are enrolled in a psychiatric insurance carve-out (usually behavioral health) can submit CPT code 90862, “Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy.” He said that family physicians and other physicians are restricted to the evaluation and management (E/M) visit codes. Does CPT make this restriction?
No. In fact, CPT states that “it is important to recognize that the listing of a service or procedure and its code number in a specific section of this book does not restrict its use to a specific specialty group. Any procedure or service in any section of this book may be used to designate the services rendered by any qualified physician or other qualified health care professional.”
So, from a CPT perspective, family physicians can submit code 90862. Whether they will get reimbursed for it depends on a health plan’s payment policy. Some health plans may use mental health and behavioral health carve-outs that preclude payment for 90862 except when billed by a psychiatrist or other designated mental health professional such as a psychiatric APRN, as your coding expert described. This effectively limits the use of this code to those specialties, despite the language in CPT quoted above.
For more information on the proper use of code 90862, see “Pharmacologic management,” FPM, May 2003, page 17.
When I do an electrocardiogram (ECG) for a patient presenting with a symptomatic illness (e.g., chest pain, dizziness and diaphoresis), what ECG code should I submit? I have been told that CPT code 93000 is only for a “routine” ECG and, therefore, not appropriate in this case. However, I have reviewed CPT’s cardiography codes (93000-93278), and I could not locate a more appropriate code than 93000, “Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report,” tagged with the stated primary symptomatic illness. Am I missing something?
I don’t think so. I agree that 93000 tagged with the stated primary symptomatic illness appears to be the most appropriate way to code the service you’ve described. “Routine” in the descriptor refers to the performance of the ECG (i.e., this ECG is more routine than rhythm strips, stress ECGs, Ergonovine provocation and microvolt T-wave alternans) rather than the condition of the patient, so the code should still be valid with symptomatic patients. Also, I am not aware of any other code that Medicare or other payers would direct you to use in this situation. In fact, Medicare reimbursed code 93000 almost 10 million times in 2001, which would not be the case if the code was not to be used with symptomatic patients.
Does the term “biopsy” in the descriptor for CPT code 11100, “Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; single lesion,” mean that the code only applies to a partial lesion removal as opposed to a full excision?
“Biopsy” in the context of 11100 does generally mean less than a full excision. However, in some cases, 11100 can be used even when the biopsy procedure results in the removal of the entire lesion. It depends on the intent of the procedure. If the intent is to identify the lesion and/or determine whether additional treatment is necessary, code 11100 would be appropriate, regardless of whether the lesion is completely or partially removed. If the intent is to remove the lesion, an excision or shave-removal code would be appropriate.
If I perform cryotherapy on three warts, I know I should submit 17000, “Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), all benign or premalignant lesions (e.g., actinic keratoses) other than skin tags or cutaneous vascular proliferative lesions; first lesion,” once for the first lesion and 17003, “... second through 14 lesions, each (List separately in addition to code for first lesion),” with 2 units of service for the other lesions. But do I also need to attach modifier -59, “Distinct procedural service,” or modifier -51, “Multiple procedures,” to 17003?
No, you do not need to attach a modifier to 17003. Since the descriptor for 17003 indicates that these are separate lesions, modifier -59 is not necessary. Further, 17003 is a designated add-on code, which means that it is “exempt from the multiple-procedure concept,” according to CPT. Note that destruction of flat warts should be coded with 17110 or 17111 instead.
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If I attempt to start an IV for blood collection in the office (e.g., on an infant suspected of sepsis) but, after several attempts, abort the effort and send the patient to the hospital for admission, what code(s) should I submit for the failed attempts?
You should submit the appropriate IV or venipuncture code (e.g., 36400, “Venipuncture, under age 3 years, necessitating physician’s skill, not to be used for routine venipuncture; femoral or jugular vein”) with modifier -52, “Reduced services,” attached. This modifier indicates that the service was reduced or eliminated at the physician’s discretion.