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Neurosurgery Coding Alert

CPT 2002:
Neurosurgery Practices Prepare for Code Changes and Revisions
Changes affecting neurosurgery will generally clarify or narrow previous d... Read more
2002 OIG Work Plan:
Focus on ABNs and Incident to
The Office of Inspector General (OIG) has released its work plan for fiscal year 2... Read more
Reader Question:
Reporting ACDF
Question: Our neurosurgeon performs ACDF surgeries with anterior cervical plate fixati... Read more
Reader Question:
Stereotactic Procedure
Question: Our local Medicare carrier denies 61795 if it is not used with 61793. Is this co... Read more
Reader Question:
E/M Service With ICP Monitoring
Question: A neurosurgeon sees a patient in the emergency department. He admits the patient... Read more
Reader Question:
H&P for Readmission
Question: A patient underwent L4/5 diskectomy and was discharged on the third day followin... Read more
You Be the Coder:
Pneumocele Repair
Test your coding knowledge.  Determine how you would code this si... Read more
Learn Treatment Options for Trigeminal Neuralgia and Receive Proper Payment
Neurosurgeons may select from several treatment options for trigeminal neuralgia (350.1)... Read more
Guidelines To Distinguish Modifiers -58, -78 and -79
Occasionally, a surgeon must return a patient to the operating room (OR) during th... Read more
CCI Update:
Version 7.3 Brings Minimal Changes
Version 7.3 of the Correct Coding Initiative (CCI) has been released on behalf of CM... Read more
News Brief:
Revised ICD-9 Codes Effective Oct. 1
CMS program memorandum transmittal AB-01-91, change request 1661, dated June 28, 2001, p... Read more
Reader Question:
Bilateral Corpectomies
Question: How should I code a posterior approach for a thoracic or lumbar corpectomy (tr... Read more
Reader Question:
Sacral Foraminotomy
Question: A window laminotomy was performed at L5. Foraminotomies were then performed at... Read more
You Be the Coder:
Halo Removal
Test your coding knowledge.  Determine how you would code this situation before l... Read more
Head Off Denials:
Reporting Definitive Skull-Base Procedures and Repairs
Coding for definitive skull-base procedures is complicated by the number of codes, t... Read more
Im Not Even Supposed To Be Here Now! Getting Paid After Hours
After-hours codes 99050-99054 are designed to reimburse physicians who see patients at... Read more
Correction:
Time-Based Consults
  The September 2001 Neurosurgery Coding Alert incorrectly reported that if a phys... Read more
Reader Question:
Radiosurgery
Question: Our physicians apply the head ring for radiosurgery and perform the mapping and ... Read more
Reader Question:
Billing Nerve Blocks for Medicare
Question: How should I report bilateral paravertebral articular nerve blocks for Medicar... Read more
Reader Question:
Multiple Surgeons
Question: Two neurosurgeons work for the same practice. Surgeon A performs a cervical deco... Read more
Reader Question:
Pseudoarthrosis Removal With Redo Laminotomy
Question: How should I report the removal of pseudoarthrosis with a redo laminotomy?Neva... Read more
You Be the Coder:
Shunt Externalization
Test your coding knowledge.  Determine how you would code this situation before loo... Read more
Dont Lose Your Head Determine Which Skull-Base Surgery Approach Codes Are Correct
Any one of 14 codes (61580-61598) can describe the approach during skull-base su... Read more
Modifier -22:
Append Carefully for Proper Compliance
Proper use of modifiers is as essential to accurate coding and successful billing as sel... Read more
News Brief:
Draft E/M Guidelines Scrapped
On July 19, 2001, Tommy Thompson, secretary of the Department of Health and Human Services... Read more
Reminder:
Resubmit Same-Day E/M, Diagnostic Test Claims by Oct. 1
In October 2000, version 6.3 of the national Correct Coding Initiative (CCI) added more th... Read more
Reader Question:
Coding for VectorVision
Question: Which code should I use for a VectorVision during a craniotomy?Utah Subscriber&n... Read more
Reader Question:
Resection of Intradural Tumor at Multiple Levels
Question: How should I report a laminectomy at T12, L1 and L2 for resection of an intradur... Read more
Reader Question:
Billing a Time-Based Consult
Question: A surgeon spent 85 minutes providing a consultation for a patient in the hospi... Read more
Reader Question:
Craniotomy and Cranioplasty
Question: When performing a craniotomy followed by a cranioplasty with titanium plates, sh... Read more
You Be the Coder:
Decompression With Microdiskectomy
Test your coding knowledge.  Determine how you would code this situation before loo... Read more
Know How To Distinguish Between Spinal Surgeries When Nerves Are Not the Focus
Clinical similarities make it difficult to distinguish an anterior vertebral corpe... Read more
CCI Update:
Injection and Laparotomy Codes Are Affected
The latest version of the national Correct Coding Initiative (CCI, 7.2), effective July ... Read more
CCI Terms Defined for Easier Use and Understanding
The national Correct Coding Initiative (CCI), first issued in January 1996 and updated e... Read more
News Brief:
HCFA Changes Name to CMS
The Health Care Financing Administration (HCFA) has been renamed the Centers for Medicar... Read more
Reader Question:
Carpal Tunnel Syndrome
Question: What is the proper coding for surgical treatment of carpal tunnel syndrome?Iowa ... Read more
Reader Question:
After-Hours Codes With On-Call Status
Question: Is it appropriate to report the after-hours codes if the physician sees the pati... Read more
Reader Question:
Separate E/M With Myelography
Question: Our surgeon performs his own myelograms, usually the day before surgery. He dict... Read more
Reader Question:
When Is an Operating Microscope Reportable?
Question: In our practice, we have always thought that 69990 could be billed with proced... Read more
Reader Question:
Aneurysmal Dilation Repair
Question:  Our surgeon performed "wrapping of aneurysmal dilation of the left A2 se... Read more
You Be the Coder:
Modifier -25 With Follow-Up
Test your coding knowledge.  Determine how you would code this situation before l... Read more
Distinguish CSF Shunt Placement and Endoscopic Third Ventriculostomies for Proper Coding
" When treating patients for an excessive accumulation of cerebrospinal fluid (CSF), o... Read more
Meet the Challenge of Workers Compensation Claims
Neurosurgeons should not dread billing for work-related diseases just because the coding... Read more
HCFA Briefs:
New Modifiers Introduced
HCFA has deleted modifier -GX (service not covered by Medicare) and replaced it with t... Read more
HCFA Briefs:
Medicare Carriers Instructed To Accept Pre-Op Clearance V Codes
HCFA has revised section 15047 of the Medicare Carriers Manual (MCM) to ensure that lo... Read more
Reader Question:
Arthrodesis With Allograft
Question: A patient was diagnosed with cervical spondylosis and herniated nucleus pulposus... Read more
Reader Question:
Add-On Codes Should Be Paid at Full Fee
Question: We have received payment reductions and denials when billing for multi... Read more
Reader Question:
Lumbar Fusion With Instrumentation
Question: The neurosurgeon performs a surgical procedure including a posterior lumbar fu... Read more
You Be the Coder:
Pseudoarthrosis Removal
Test your coding knowledge.  Determine how you would code this situation before l... Read more
Improve Pay Up with Proper Modifiers for Substitute Neurosurgeons
Obtaining reimbursement from Medicare for procedures performed by substitute neurosurgeons... Read more
Dont Forget to Code for all Aspects of PLIF to Achieve Optimal Reimbursement
When billing for a posterolateral interbody fusion (PLIF), such as code 22630 (arthrodesis... Read more
News Brief:
Supervision Requirements for Medicare Diagnostic Tests
HCFA has released Program Memorandum No. B-01-28, dated April 19, 2001, outlining the supe... Read more
Reader Question:
Endonasal Transsphenoidal Resection
Question: If a neurosurgeon uses fluoroscopic guidance during an endonasal transsphenoidal... Read more
Reader Question:
Billing 63047 and 22630
Question: Is it appropriate to bill 63047 with 22630?California Subscriber Answer: It is... Read more
Reader Question:
Coding for Needle Biopsy
Question: How would the following surgery be coded? The operative note reads: Transoral ne... Read more
Reader Question:
Charging for X-ray, MRI Interpretations
Question: Can neurosurgeons charge for reading x-rays and MRIs taken at an outside facili... Read more
Reader Question:
Segmental vs. Non-segmental Instrumentation
Question: If a neurosurgeon places pedicle screws at L3 and L5 and connects a rod between... Read more
Reader Question:
Payment for Travel
Question: Our physician assistant (PA) traveled to a patients home to refill his pain pump... Read more
Reader Question:
Workers Compensation Fee Schedule
Question: I have a workers compensation carrier that I dont think paid enough. Where is th... Read more
Reader Question:
Craniofacial Surgeries
Question: Our neurosurgeon performs craniofacial surgeries with a plastic surgeon. The pla... Read more
You Be the Coder:
Lumbar Fusion
Test your coding knowledge. Determine how you would code this situation before looking at... Read more
Coding Tactics to Get Paid for Laminectomies
"Obtaining reimbursement for laminectomies is often difficult because of confusion regardi... Read more
Proper E/M Coding for the Decision to Perform Surgery in the ED
Billing for consultations that result in the decision to perform surgery can be challengin... Read more
News Brief:
CCI 7.1: Neurosurgery Update
Effective April 1, thoracic CAT scan codes 72128, 72129 and 72130 are bundled into thoraci... Read more
Reader Question:
Resection of Pineal Tumor
Question: What is the optimal coding for resection of a pineal tumor via a suboccipital cr... Read more
Reader Question:
Removal of Sutures
Question: What CPT and ICD-9 codes should I use when suture removal is done in the neurosu... Read more
Reader Question:
Two Interspace Corpectomy
Question: How should I code the following: Left sided thoracoabdominal approach to the lat... Read more
Reader Question:
Collecting Copayments
Question: When a patient is asked to pay a copay and cannot, are we legally bound to send ... Read more
Reader Question:
Balloon Angioplasty
Question: One of our neurosurgeons performs interventional endovascular procedures. Rece... Read more
Reader Question:
Anterior Lumbar Diskectomy
Question: A neurosurgeon performed an anterior lumbar exposure, a radical diskectomy L4-L5... Read more
You Be the Coder:
Retained Shunt Tubing
Question: A patient underwent a shunt revision. The shunt was converted from a ventriculo-... Read more
Five Tips to Avoid Denials and End Pay Up Reductions for Spinal Instrumentation
Neurosurgery claims for spinal instrumentation (22840-22848) are being reduced and denied ... Read more
Stereotactic Brachytherapy:
Methods to Ensure Reimbursement
There is often confusion regarding additional codes that can be billed with stereotactic ... Read more
Skull Base Surgery:
Get Paid for Postoperative Complications
Coding for a repair of dura for cerebral spinal fluid (CSF) leak (61618 or 61619) in the w... Read more
Reader Question:
Bone Flap Implantation
Question: During a hemicraniectomy, 61542, the neurosurgeon implanted the bone flap in the... Read more
Reader Question:
Removal of Subcutaneous Reservoir
Question: How should i code the removal of a subcutaneous reservoir? The placement code is... Read more
Reader Question:
Repeat Bilateral Laminectomy
Question: How should I code the following: repeat bilateral lumbar laminectomy and foramin... Read more
Reader Question:
61770 and 61751
Question: Can we bill for a biopsy at the same time as placing a gliadel wafer? If so, can... Read more
Reader Question:
Excision of Arachnoid Cyst
Question: How should the following be coded: Decompressive thoracic laminectomy, T3-T10 w... Read more
Reader Question:
Decision for Neurosurgery
Question: A neurosurgeon saw a patient in the hospital and decided surgery was needed (992... Read more
You Be the Coder; Bone Stimulators
Question: Is 62351 the correct code for implantation of an internal bone stimulator? How s... Read more
Pain Pumps:
Coding Tactics to Get Paid
Through documenting the ineffectiveness of other pain management and spacticity treatments... Read more
Reduce Denials for Brain Tumor and Hematoma Excisions
When billing for an excision of brain tumor (61510) and removal of a hematoma (61312) at d... Read more
Commonly Accepted ICD-9 Codes
A noncovered diagnosis can easily result in a speedy denial. ICD-9 codes commonly accepted... Read more
HCFA Suspends Significant Portion of CCI 6.3
According to HCFA Program Memorandum B-01-09 dated Feb. 8, 2001, HCFA has temporarily su... Read more
Reader Question:
Coding for ACDF
Question: The neurosurgeon performed an anterior cervical diskectomy and fusion (ACDF) at ... Read more
Reader Question:
Lobectomy Coding
Question: When the epileptogenic focus (the tissue of the brain from which epileptic seizu... Read more
Reader Question:
Laminectomy with Biopsy
Question: We performed a laminectomy at L4, L5 and S1. We thought we would be removing a l... Read more
Reader Question:
Reprogramming a VP Shunt Valve
Question: Is there a CPT code for reprogramming a VP shunt valve?Michigan Subscriber Answe... Read more
You Be the Coder:
Silastic Dural Expansion Graft
Question: The neurosurgeon performed a craniotomy to remove a subdural hematoma. He did no... Read more
Reduce Delays and Denials with Proper Coding for Intracranial Aneurysm Surgeries
Intracranial aneurysms occur in different locations of the brain. Neurosurgeons address th... Read more
Increase Payment for New Percutaneous Vertebroplasty Codes
The introduction of percutaneous vertebroplasty codes in CPT 2001 has created excitement f... Read more
61795, 64553, 64573!:
CCI Allows Resubmission of Denials
In the recently released Correct Coding Initiative (CCI) 7.0, several major changes were... Read more
RVU Update:
Intracranial Aneurysm Codes
The current relative value units (RVU) for CPT codes 61697, 61698, 61700 and 61702 appear... Read more
HCFA Alert:
Discontinue Use of the New Modifier -60
In the December issue of Neurosurgery Coding Alert we reported on a new modifier (modifier... Read more
Reader Question:
Vertebral Segments
Question: Codes 63045-63047 refer to vertebral segments. Does this identify a single verte... Read more
Reader Question:
Microlaser Diskectomies
Question: During microlaser diskectomies the neurosurgeons use a CO2 laser. I use 66821 to... Read more
Reader Question:
Posterior Thoracic Microdiskectomy
Question: What code would you use for a posterior thoracic microdiskectomy?Florida Subscri... Read more
You Be the Coder:
61210 and 61215
Question: When performing the placement of a ventricular catheter and subcutaneous reservo... Read more
Laminectomies vs. Laminotomies:
Knowing the Difference Minimizes Denials, Increases Revenue
Reducing claim denials and payment delays for laminectomies and laminotomies often comes d... Read more
Including A Findings Section in Your Operative Report Can Make Billing Easier
Neurosurgeons should include a short section in their operative notes explaining what they... Read more
Medical Necessity Crucial to Get Paid for Spinal Endoscopies
New procedures and techniques are constantly being added to the neurosurgery field. Althou... Read more
Reader Question:
Fluoroscopic Guidance
Question: If a neurosurgeon uses fluoroscopic guidance in spine surgery (diskectomy and fu... Read more
Reader Question:
Bone Grafts
Question: If a neurosurgeon uses a femoral ring allograft and an iliac bone graft, should ... Read more
Reader Question:
Billing for Canceled Surgery
Question: A neurosurgery patient was intubated, and general anesthesia was established. Th... Read more
Reader Question:
Critical Care Coding with Multiple Physicians
Question: My practice has a heavy trauma volume and manages critical care issues for head-... Read more
Reader Question:
Debulking with Craniotomy
Question: One of our neurosurgeons performed a CT-guided stereotactic brain biopsy. A coup... Read more
Reader Question:
Mutually Exclusive
Question: What does the phrase mutually exclusive mean in the CCI updates?California Subs... Read more
You Be the Coder:
Extensive Laminectomy
Question: How is the following procedure coded? An extensive decompressive laminectomy L2-... Read more
Available Years:  2001  2000