CPCA CPT for Aesthetic Procedures 4 — Questions and Answers
Question 1: Bilateral upper eyelid blepharoplasty is performed during the same session. How should this be reported?
- 15822 with modifier 50 (Correct answer)
- 15822 reported once (bilateral is included in the descriptor)
- 15822 on two separate lines without modifier
- 15822 and 15820 on separate lines
Correct answer: 15822 with modifier 50
Bilateral blepharoplasty is reported with CPT 15822 and modifier 50 to indicate the procedure was performed on both upper eyelids.
Question 2: A cosmetic procedure is performed for which no specific CPT code exists. What coding approach is most appropriate?
- Use the nearest anatomically related CPT code without modification
- Report an unlisted procedure code for the appropriate body system (Correct answer)
- Assign a Category III code regardless of the procedure type
- Apply modifier 52 to a related procedure code
Correct answer: Report an unlisted procedure code for the appropriate body system
When no specific CPT code describes a cosmetic service, the appropriate unlisted procedure code for that body system is reported.
Question 3: Modifier 22 is appended to a rhinoplasty code. What does this communicate to the payer?
- The procedure was performed bilaterally
- The work required was substantially greater than typically described by the code (Correct answer)
- The procedure was terminated before completion
- A second surgeon assisted with the procedure
Correct answer: The work required was substantially greater than typically described by the code
Modifier 22 (Increased Procedural Services) indicates the work required was substantially greater than typically described by the CPT code.
Question 4: Which criterion most commonly determines whether a rhinoplasty qualifies for insurance coverage rather than being classified as cosmetic?
- Patient age under 21 years
- Documented nasal obstruction causing functional breathing impairment (Correct answer)
- Procedure performed in a hospital inpatient setting
- Surgeon's subspecialty board certification in rhinology
Correct answer: Documented nasal obstruction causing functional breathing impairment
Insurance coverage for rhinoplasty typically requires documented functional impairment such as nasal obstruction affecting breathing.
Question 5: A brow lift and blepharoplasty are performed by the same surgeon during the same operative session. How should these be reported?
- Report only the brow lift as the primary and higher-valued procedure
- Report only the blepharoplasty because it has a higher relative value
- Report both procedures with modifier 51 on the secondary procedure (Correct answer)
- Report both procedures with modifier 59 on each
Correct answer: Report both procedures with modifier 51 on the secondary procedure
When two distinct procedures are performed during the same session by the same surgeon, both are reported with modifier 51 appended to the secondary procedure.
Question 6: What is the standard global surgical period for major aesthetic procedures such as abdominoplasty?
- 0 days
- 10 days
- 45 days
- 90 days (Correct answer)
Correct answer: 90 days
Major surgical procedures, including most aesthetic surgeries such as abdominoplasty, carry a 90-day global surgical period.
Question 7: A dermal filler is injected into facial rhytids at 9 discrete intralesional sites. Which CPT code is reported for the injection service?
- 11900
- 11901 (Correct answer)
- 11920
- 64612
Correct answer: 11901
CPT 11901 describes intralesional injection at more than 7 lesions and applies when filler is injected at more than 7 facial sites.
CPCA CPT for Aesthetic Procedures 4
Bilateral upper eyelid blepharoplasty is performed during the same session.
How should this be reported?