AI and automation are changing the way we code and bill, folks! It's like having a robot that's really good at following a bunch of crazy rules. We all know that medical coding is fun, right? It's like solving a puzzle, but instead of getting a cute picture at the end, you get a bunch of numbers and letters that somehow determine how much money we get paid.

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As medical coding professionals, we are tasked with accurately representing the services provided by healthcare providers using a standardized language understood by insurance companies and other healthcare stakeholders. This requires a deep understanding of medical terminology, anatomical structures, and the nuances of procedures performed. This article focuses on CPT code 20982 and provides examples of its application. The use of correct modifiers ensures accurate reimbursement and helps maintain the integrity of medical coding practice.

Understanding CPT Code 20982

CPT code 20982 is a five-digit code used to bill for the radiofrequency ablation of bone tumors. It includes the use of imaging guidance for precise targeting and application of radiofrequency energy. This procedure typically involves a percutaneous approach, minimizing the extent of surgical incision.

While CPT code 20982 is comprehensive, it's important to be mindful of additional factors and modifiers that may be relevant in specific cases. Using modifiers allows for greater clarity and specificity in describing the procedure. Remember, correct modifier selection ensures accurate reimbursement and maintains ethical coding practices.

Modifiers and their use-cases

CPT code 20982 can be modified based on the specifics of the procedure. Some common modifiers used in this context are explained below. These modifiers will vary by situation and should only be used in a proper, well-documented scenario.

Modifier 51 - Multiple Procedures

Let’s imagine a patient with multiple bone tumors requiring ablation. In this instance, multiple lesions may be targeted in the same session, justifying the use of modifier 51 to reflect multiple procedures being performed during the same encounter.

Here is a conversation with the patient and the provider illustrating when you would use Modifier 51 * Provider: "Good morning, Mr. Jones, It looks like you have three separate tumor sites requiring ablation, are we proceeding with ablation at each of those locations today? " * Patient: “ Yes doctor, that’s what we decided on" * Provider: " Ok, so we’re going to be performing Ablation therapy of 3 tumors today" * Patient: “ Ok doctor. How much will this cost?” * Provider: “ Well, our office can't answer that as it will vary from your insurance company to your insurance company. It depends on your specific plan. It also depends on how the procedure codes get billed. You might get a much smaller bill, and you may only have to pay the coinsurance as long as there's no deductible to pay and this counts towards your deductible.” * Patient: “Thanks Doctor”

Explanation: This patient has three separate lesions to be treated, which means they’ll be receiving more than one procedure, warranting modifier 51. In this situation, using modifier 51 would ensure that the physician is appropriately compensated for the services provided as each lesion is a separate service. It’s a great way to get paid correctly and to allow patients to accurately get the full deductible that the procedure code costs on their insurance plan.

Modifier 52 - Reduced Services

Consider a case where the patient presents for a scheduled ablation but the provider determines that due to extenuating circumstances, they are only able to ablate a portion of the planned bone tumor, requiring a subsequent procedure for the remaining lesion. In such cases, modifier 52 is used to indicate that a reduced service was performed. This allows you to report the portion of the service provided while maintaining a clear record that further services are necessary.

Here is a conversation with the patient and the provider illustrating when you would use Modifier 52 * Provider: "Good morning, Mr. Jones. It appears that one of the tumor sites in your left foot may be more extensive and I'm concerned that I won't be able to reach all of the bone tumor with ablation today. I may have to take a more conservative approach today with this one and follow-up with a subsequent procedure." * Patient: “Oh no! Doctor I thought I was getting all of these tumors taken care of today” * Provider: "Mr. Jones, it's very important for me to get all of the tumor to ensure we get a good outcome from your treatment today. And so we need to come UP with a treatment plan that helps to minimize any risk of any complications, and I’d hate to be rushed on the procedure that it causes issues for you down the road." * Patient: “Alright doctor, what are you suggesting we do then?" * Provider: "Ok. We're going to proceed with ablation therapy for the two smaller tumor sites in your left foot. However, I am concerned about the tumor site that's near your ankle, and we need to come UP with a treatment plan, that addresses this so we get it all done right" * Patient: “That’s Ok Doctor. Just let me know when I’ll be coming back. I’ll have to arrange for someone to watch the kids. “ * Provider: "We will schedule that follow UP procedure as soon as you are cleared from today’s ablation.”

Explanation: In this scenario, the provider determined that due to the extenuating circumstances surrounding the tumor site in the patient’s ankle, a complete ablation couldn't be performed today, only a portion of the service was rendered, justifying modifier 52. You should indicate what portion of the service was performed, as well as schedule the appropriate follow-up code when you get a finalized note from the provider and document why the service had to be partially completed today, due to extenuating circumstances. You can also use this modifier in situations when you may be able to get the patient’s insurance to pay more upfront for their follow-up procedure, while keeping an accurate and clear documentation that you still have more services that you have yet to complete for this patient’s encounter today.

Modifier 58 - Staged or Related Procedure or Service by the Same Physician

A staged procedure occurs over several sessions. Think about a situation in which a patient requires ablation on their right femur. Due to the size and complexity of the tumor, the provider elects to perform the ablation over multiple visits, with a staged approach to prevent potential complications and minimize risks. In this scenario, modifier 58 indicates that a staged procedure or related service was performed by the same provider. This modifier clarifies that this isn't a separate encounter and reflects the continuity of care provided.

Here is a conversation with the patient and the provider illustrating when you would use Modifier 58 * Provider: "Good morning Mr. Jones, we are going to be performing ablation therapy on your right femur today. I’ve reviewed your test results and am concerned that we will have to GO in stages and do multiple treatments." * Patient: "Why doctor? What’s different about this tumor site?" * Provider: "The tumor that we’ve been discussing is bigger and closer to your knee joint. We want to be cautious to make sure it’s completely gone, while protecting the knee and your ability to be mobile. If we tried to do it all in one sitting it could impact your mobility or even cause injury.” * Patient: “How will this be scheduled and what happens if I have more of a reaction this time? What are the recovery guidelines?" * Provider: “I will explain more about the process to you when you're here for the procedure but it involves more than one appointment to help monitor the effectiveness of each treatment stage to minimize the possibility of any risks during the procedure.”

Explanation: In this scenario, the ablation will be a staged procedure; modifier 58 appropriately describes this, enabling proper reimbursement. As this case is going to be a staged procedure, we are only coding one part of the procedure; we will not use modifiers such as 51. You should document all the procedures on the patients’ charts, especially those procedures that will be a part of a multi-stage procedure. Make sure that each procedural documentation includes dates, reason for each stage and any findings from that stage that justify another procedure in the series. It is important to use proper modifiers with each service that is completed on each visit in order to get your facility compensated for all of your time and services as well as get patients to be credited for all of the medical expense incurred in their health plan’s deductible, co-pay, and coinsurance.

Important legal reminders about using CPT codes:

As coding professionals, we need to always remember that CPT codes are proprietary and owned by the American Medical Association (AMA). The AMA has exclusive ownership rights to the CPT codes, and it’s a federal requirement to purchase a license for use of these codes. Unauthorized use of these codes can lead to significant penalties including fines, lawsuits, and potential legal actions. You will be required to use the most current edition of the AMA CPT codes to ensure proper compliance with federal and state guidelines and maintain ethical coding practices.

Disclaimer: It is critical to reiterate that this article is for educational purposes only. We strongly encourage readers to consult the official CPT® manual published by the American Medical Association (AMA) for the most accurate and up-to-date information on coding practices. Always use the latest AMA CPT codes. It is critical to stay informed and keep current on coding regulations.

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