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Modifier 77 vs. Modifier XP

Question: Would you have any insight into what would be the differences and why a coder would use the modifier 77 versus the modifier XP? They seem to be the same for me. I think of the XP modifier as being established for CCI instances, but if there are separate providers on a professional claim...

Moderate Sedation and Independent-trained Observer

Question: In the AMA CPT 2017 Professional edition, on page 676-677, they outline an independent-trained observer (qualified to monitor the patient during the procedure, who has no other duties during the procedure). Then on page 677 under the intraservice work, they note intraservice time is used to determine the appropriate CPT to use during the procedure. Then...

Percutaneous Transluminal Angioplasty

Question: If PTA of the venous and arterial anastomosis are performed, do we code for both a venous PTA (35476) and an arterial PTA (35475), or just one? Answer: It’s important to note that coding for these procedures will change effective January 1, 2017.  So, if you’re looking at claims prior to January 1, 2017, the April...

Mirror Therapy

Question: Please advise the appropriate CPT code to use for mirror therapy performed by PT/OT. Answer: There is no CPT code for mirror therapy and, generally, payers consider this type of therapy to be experimental and it isn’t covered. While you could consider CPT code 97799 (Unlisted physical medicine/rehabilitation service or procedure), we would recommend you...

Transvaginal Ultrasound

Question: Is there a way to code for a transvaginal ultrasound for a second fetus Answer: There are several codes that may apply to this scenario as noted below: 76813 (Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or first gestation) 76814 (Ultrasound, pregnant uterus, real...

Pediatric Full-body DEXA Scan

Question: We have a company that would like us to provide a full-body DEXA on a pediatric patient. We are having difficulty determining what CPT would be appropriate for that. Can you tell us that? Answer: There is no CPT code to report a full-body DXA scan. This procedure should be reported using the unlisted...

Modifier GY

Question: Is the GY modifier necessary on all drugs that are considered self-administered when administered in an outpatient setting; emergency department, observation and facility-based clinics? What is the appropriate use of the GY modifier? Answer: It is not necessary to place the GY modifier on drugs considered self-administered. Revenue code 637 – Self-Administrable Drugs may be assigned...

Sodium Bicarbonate Infusion

Question: We are a hospital (technical) setting. Can we bill for a sodium bicarbonate infusion when it is done in conjunction with a CT scan with contrast to prevent Contrast-Induced Nephropathy? The NCCI edit leans towards a yes, with an appropriate modifier.  The bicarbonate is infused to help the patient’s body accept/take the contrast. Answer: As...

Embryo Cryopreservation

Question: If an embryo freeze is performed on day 5 and again on day 6, can the 89258 be charged on both day 5 and on day 6? Answer: Yes, CPT code 89258 – Cryopreservation; embryo(s) may be charged on both day 5 and day 6. The following information is found in AMA CPT® Assistant, April 2004: “Code 89258,...

Reporting Moderate Sedation

Question: Our external billing scrubber is advising to append modifier 25 with CPT 99152 when also billing CPT 36561. Could you please provide any information? They are referencing the “Integrated OCE (IOCE) CMS Specifications V17.1.” Could you please assist? Answer: With the elimination of Appendix G from the CPT book and implementation of new CPT...