CPT 95865

Question: When performing electromyography (EMG) on cranial nerve supplied muscles via the endotracheal tube sticker electrode, the sticker electrode measures one channel of EMG from both sides. Thus, it is bilateral monitoring with a single channel. Would that be considered unilateral (95867) or bilateral (95868)?

Answer:

Code 95865, Needle electromyography; larynx, should be reported as opposed to 95867 or 95868. Code
95865 represents inherently bilateral recording.

CPT 93623

May code 93623 be reported for an isoproterenol study postablation following a single catheter electrophysiologic study with induction of arrhythymia, ablation of supraventricular tachycardia, and postablation injection of isoproterenol?

Answer:

Although it is extremely unusual to record and pace from only one or two sites within the heart, there
are still occasional circumstances for which singlecatheter studies for either recording and/or pacing
might be undertaken. Because code 93623, Programmed stimulation and pacing after intravenous drug infusion (List separately in addition to code for primary procedure), is reportable only in conjunction with 93619 and 93620, code 93624, Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or attempted induction of arrhythmia, is reported to describe follow-up electrophysiologic study of the efficacy of any therapy undertaken, including any therapy initiated, whether pharmacologic, surgical, or catheter ablation, or device therapy.

Also reportable is code 93618, Induction of arrhythmia by electrical pacing, which is used to report insertion of a single catheter for the purpose of inducing an arrhythmia. This procedure is rarely performed in and of itself because, in most instances, further evaluative studies and mapping of the arrhythmia would also be performed. Code 93651, Intracardiac catheter ablation of arrhythmogenic focus; for
treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathways, accessory atrioventricular connections or other atrial foci, singly or in combination, is reported to describe the catheter ablation procedure.

Modifier 51 should not be appended to 93600, 93618, 93621-93623, and 93631.

Can CPT 96365 be used twice during the same visit ?

 A patient is admitted to observation and the physician orders an antibiotic IVPB administered over one hour and repeated every eight hours. The patient receives the first dose from 12 pm to 1 pm and the next dose from 8 pm to 9 pm. Would this be reported with codes 96365 and 96367?

Answer:
The facility may report code 96365, Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify sub-
stance or drug); initial, up to 1 hour, for the first intravenous infusion of the antibiotic and code 96367, Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion, up to 1 hour (List separately in addition to code for primary procedure), to reflect the second antibiotic infusion.

The rationale for reporting both codes 96365 and 96367 relates to the use of only one initial service code
per IV site per encounter. The observation stay for that date would be considered a single encounter, for which 96365 and 96367 are reportable.

CPT 87804

Please clarify whether reporting code 87804 two times, once with modifier 59 (87804, 87804 59), would
be appropriate for differentiating rapid influenza tests; those providing separate, distinct results for both strains A and B on one device.

Answer:
The detection of both influenza A and B strains may be part of two entirely separate procedures or may be
included within the same test device because these two analyses are not uncommonly requested by the clinician together. If the assays provided two separate results (eg, a result for influenza A and a result for influenza B), two units of 87804 would be appropriate. Modifier 59, Distinct procedural service, may be used to indicate that the two results represent separate services, when two units of 87804 are submitted.

CPT 86945

Can we report 86945 when the patient requires irradiated platelets per the attending physician order (even though the product was not actually irradiated for that specific patient)? Can we report 86945 when the clinical record indicates the patient does not require irradiated platelets (ie, the attending physician does not order irradiation)?

Answer: 
Yes, you may report code 86945, Irradiation of blood product, each unit, when the patient requires
irradiated platelets per the attending physician order even though the product was not actually irradiated for

that specific patient. It would not be appropriate to report code 86945 in the event the blood bank-transfusion service has chosen to irradiate all platelets when (a) it might not be indicated and/or (b) a physician order for that irradiated product (the only product stored, having irradiated them all) is lacking.

CPT 88285 chromosome analysis

Is it appropriate to report code 88285 per each additional cell counted beyond the number specified in the base code (eg, 88261 or 88262), or does it cover all additional cells counted for the study (ie, single test result)? For example, 10 cells are counted instead of five as specified in the descriptor.
Do I report code 88285 once or five times to account for the analysis of the additional cells?

Answer:

Code 88285, Chromosome analysis; additional cells counted, each study, should be reported once because the descriptor nomenclature indicates the analysis of additional cells (plural). Therefore, it would not be appropriate to report five units of code 88285 for the analysis of five additional cells.

Laboratory tests done more then once require which CPT modifiers?

Is it necessary to use modifier 59, Distinct procedural service, when laboratory tests contain the same CPT
code more than once? For example, flow cytometry studies may involve reporting 88184 and 88185 x3. Would modifier 59 be appended to the second and third use of 88185?

Answer:
From a CPT coding perspective, it is not necessary to append modifier 59, Distinct procedural service, to CPT add-on codes because these codes represent additional or incremental work associated with the basic procedure performed. Code 88185, Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; each additional marker (List separately in addition to code for first mark er), is an add-on code reported in conjunction with 88184.