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Neurosurgery Coding Alert

Prove It or Lose It:
Show Medical Necessity, Evidence of Trials
If you fail to show that a patient hasn't responded to less invasive treatments, chances a... Read more
Improve Your Coding Right Now With Late Effects
More detail means better claims success, experts say If you're overlooking late effects w... Read more
Want to Avoid OIG Scrutiny?
Shore up your diagnostic testing claims, medical necessity in 2004 You've assigned the ri... Read more
News You Can Use:
CMS Makes It Easier (and Cheaper) to Get NCCI
Tired of shelling out hundreds of dollars a year to stay current on National Correct Codin... Read more
Reader Question:
Instrumentation Codes Are Bilateral
Question: Are instrumentation codes 22840 and 22842 unilateral only? For example, if the s... Read more
Reader Question:
Bill On-Call Visits as 'Established'
Question: Our physician is now "on-call" for another surgeon. If he sees a patient for the... Read more
Reader Question:
Don't Use 64640 Indiscriminately
Question: May we report 64640 for Botox injections? We now use 64612 for facial, 64613 for... Read more
Reader Question:
Use 63030 for Repeat Diskectomy During Global
Question: If a patient has a repeat lumbar micro-diskectomy for a recurrent herniated disk... Read more
Reader Question:
Use 64470 Range for Medial Branch Blocks
Question: Which code should we report for a medial branch block?New Jersey Subscriber Ans... Read more
Reader Question:
Code 22851 for PEEK
Question: Our surgeon recently used a new system called "PEEK" for an interbody fusion usi... Read more
You Be the Coder:
How to Code for Microlaser
Question: What is the best code to describe microlaser diskectomy? CPT does not contain a ... Read more
Get the Pay You Deserve for Long Visits
Here's the scoop on 99354  If your neurosurgeon provides an extended E/M visit, you... Read more
If Prolonged Services Don't Apply, Try Modifier -21
Modifier -21 can allow you to recoup additional E/M reimbursement when the physician's ser... Read more
Quick Quiz:
Test Your Prolonged Service Skills
You're fairly clear on prolonged services codes, but you'd like a little practice, right? ... Read more
Are You Missing Out on PLIF Reimbursement?
Here's how to break down fusions to improve billing If you're reporting posterior lumbar... Read more
You Can Use Modifier -32 for Confirmatory Consults
If you're not using modifier -32 (Mandated services) for confirmatory consults, you're sur... Read more
Beyond the Three R's
Experts advise you on choosing a consult category After you've documented a request, reas... Read more
Reader Question:
90846 Describes Psychiatric Services Only
Question: May I report 90846 if the neurosurgeon meets with a patient's family to discuss ... Read more
Reader Question:
Select 62230 for Shunt Externalization
Question: What is the best code for cerebrospinal fluid (CSF) shunt externalization?Texas ... Read more
Reader Question:
Append Modifier -50 for Bilateral Facet Injections
Question: Should I report bilateral facet joint injections by using modifier -50 or by usi... Read more
Reader Question:
Separate Incision Means Separate Ventriculostomy
Question: Can I report 61107 or 61210 to place a drain for intraoperative ventricular deco... Read more
You Be the Coder:
Can a Surgeon Charge for Radiology Procedures?
Question: A patient presented for follow-up four months after surgery. The physician provi... Read more
Want to Give Your Bilateral Spinal Surgery Claims Backbone? Turn to Modifier -50
If your spine surgeon performs bilateral surgeries such as lumbar laminotomies (63030), yo... Read more
Reporting Mini-Mental Exams Correctly (Hint:
Don't Use 96115)
Are you making the mistake of reporting 96115 for so-called "mini"-mental stat... Read more
Billing Consults? Here Are 3 Words You Can't Do Without
Quick: What three requirements distinguish a consult (99241-99263) from other inpatient an... Read more
Avoid 'Transfer of Care' Language When Reporting Consults
You know that you need to specify the three R's to justify a consult code. But you must al... Read more
Forget About Overpayments:
CMS Has a Change of Heart Concerning Proposed 'Mass Adjustment'
Good news for your neurosurgery practice: Your physicians won't have to cough up overpayme... Read more
Reader Question:
Use -57 for Admission and Same-Day Procedure
Question: May I report a hospital admission and procedure on the same day? My payer has be... Read more
Reader Question:
Choose 61210 for Frontal Ventriculostomy
Question: What is the correct code for right frontal ventriculostomy? The operative report... Read more
Reader Question:
Use M Codes at Payer/Facility Request
Question: What are 'M' codes? Should I use them?California Subscriber Answer: M codes (fo... Read more
Reader Question:
Use 64470-64476 Range for Medial Branch Blocks
Question: Which code should we report for a medial branch block?New Jersey Subscriber Ans... Read more
Reader Question:
Don't Confuse 'XXX' and '000' Global Periods
Question: What's the difference between an 'XXX' global period and a '000' global period?I... Read more
Reader Question:
You Can Report -62 With 22855
Question: I recently submitted a claim for two surgeons acting as co-surgeons during remov... Read more
You Be the Coder:
What's the Code for RFTC?
Question: Our surgeon performed a radiofrequency thermal coagulation (RFTC) to disable the... Read more
Percutaneous Vertebroplasty or Kyphoplasty? 5 Easy-to-Follow Steps Can Boost Your Pay
Are you coding percutaneous vertebroplasty and kyphoplasty the same way? If so, you could ... Read more
Getting the Pay You Deserve in Group Practice Coding
What should you do when your physician treats a patient during the global period of a proc... Read more
'Starred' Procedures:
Should You Worry About a Global Period or Not?
What if you could bill for services, such as follow-up E/M care, normally included in the ... Read more
Reader Question:
Use -LT and -RT With 63056
Question: Does 63056 represent a bilateral or a unilateral procedure? Washington Subsc... Read more
Reader Question:
Medicare Specifies -AS for PAs in Surgery
Question: In the past, I've always reported modifier -80 for a certified PA in the opera... Read more
Reader Question:
Laser Codes Just Like Scalpel
Question: How may I report use of a CO2 laser during open diskectomy? Arizona subscribe... Read more
Reader Question:
You Can Report +61795 for Spine
Question: Our surgeon used stereotactic navigation (61795) during laminectomy with fusio... Read more
You Be the Coder:
Does Debulking Include Craniotomy?
Question: Several hours after CT-guided stereotactic brain biopsy, a patient developed a h... Read more
Stereotactic Brachytherapy:
Heres How to Get All the Payment You Deserve
If you think neurosurgeons can only report a single code (61770) for patients undergoi... Read more
Look to Modifier -22:
Gain Additional Reimbursement for Difficult Procedures
If your neurosurgeon performs an especially difficult or time-consuming procedure that w... Read more
CCI Update:
Stereotactic G Code Gains
The newly released version 9.2 of the National Correct Coding Initiative (NCCI) classifi... Read more
2004 Brings ICD-9 Codes for Muscle Weakness, Concussion
A new code will finally allow physicians to specify a diagnosis of muscle weakness. Now,... Read more
Reader Question:
Credentialing Counts
Question: Our new associate started with us a few months ago, but we did not get him crede... Read more
Reader Question:
20975 Is the Usual Choice for Bone Stimulators
Question: Which code describes implantation of an internal bone stimulator? What about ext... Read more
Reader Question:
Use Stereotactic Code for VectorVision
Question: What is the proper code for VectorVision? New York Subscriber Answer: The cor... Read more
Reader Question:
When Is After Hours?
Question: Recently we've had an unexpected patient load and were thinking of offering ... Read more
Reader Question:
61154 Specifies Multiple Holes
Question: The surgeon used a left frontal burr hole to drain a subdural hematoma followe... Read more
Reader Question:
Use -62 for Cooperative Shunt Placement
Question: During placement of a ventriculo-peritoneal shunt, my surgeon inserted the ven... Read more
You Be the Coder:
Whats Best for Re-Exploration?
Question: Im having difficulty coding a right L4-5 redo laminectomy, foraminotomy and disk... Read more
New Guidelines Mean Broader Application of Deep Brain Stimulation Codes
New CMS guidelines allow for broader use of deep brain stimulation (DBS) for treatment of ... Read more
Neurostimulators:
Dont Forget To Charge for Programming
If you forget to charge for programming of a deep brain stimulation (DBS) unit, you ... Read more
An ED Visit and Admission on The Same Day? Heres How
How can you code for optimal reimbursement if the surgeon sees a patient in the emergency ... Read more
Reader Questions:
Time Can Determine E/M Level
Question: Ive recently been told that I can use time as the determining factor when choosi... Read more
Reader Questions:
Medicare Wont Pay for Routine Follow-Up
Question: How should I code if a patient continues to follow up with a doctor after the in... Read more
Reader Questions:
No Fixed Guidelines for Modifier -63 Yet
Question: What can you tell me about the new-for-2003 modifier -63?Georgia Subscriber A... Read more
Reader Questions:
Additional Levels Often Dont Need Modifiers
Question: What is the correct modifier to use to denote additional levels during the same ... Read more
You Be The Coder:
Whats the Code for a Shunt Tap?
Question: How should I code for a shunt tap?Iowa SubscriberAnswer: The appropriate code to... Read more
Let Vocabulary Be Your Guide When Selecting Among Spinal Codes
Coders trying to decipher operative reports cannot always easily tell the differ... Read more
Search for Key Words in the Operative Report When Selecting Spinal Codes
When you report spinal procedures, key words in the operative report can guide your co... Read more
A Spoonful of NCCI Makes the Medicine (Payments) Go Down
Of the more than 4,700 changes to the National Correct Coding Initiative (NCCI) this q... Read more
Global Periods, Part 3:
Apply Modifiers for Staged Procedures,IncompleteCare
In some cases, surgeons may provide separately reportable, "staged" procedures durin... Read more
Reader Question:
Choose the E/M Guidelines That Suit You Best
Question: Which guidelines for E/M documentation (1995 or 1997) should we use when rev... Read more
Reader Question:
Prolonged Services OK for Unresponsive Patient
Question: If a patient has had a stroke and cannot communicate or is otherwise unrespo... Read more
You Be the Coder:
Which Modifier Is Best for PAs in Surgery?
Test your coding knowledge. Determine how you would code this situation before looki... Read more
Updated Sacral Nerve Stimulation Coverage Stresses Proper Documentation
Medicare recently revised and consolidated its coverage of sacral nerve stimulation ... Read more
Global Periods, Part 2:
To Bill or Not to Bill Post-Op Complications?
Although not uncommon, complications following surgery are an uncommonly troubleso... Read more
News You Can Use:
Medicare Payments Rising, but Expect Some Challenges
On Feb. 28, Medicare published an update to its final rule for the 2003 Physician Fee ... Read more
Reader Question:
Insurer Has Final Say on Modifiers
Question: An insurer instructed us to use modifier -76 when coding second and subseque... Read more
Reader Question:
Report 63045-63048 per Segment
Question: Is it appropriate to report laminectomy codes 63045-63048 per segment or per... Read more
Reader Question:
Unlisted-Procedure Code for Osteophytectomy
Question: The surgeon removed an osteophyte from the cervical spine that was compres... Read more
Reader Question:
BMP Is Included in Fusion
Question: The surgeon dictated that he used "BMP" during fusion. What is this, and how... Read more
You Be the Coder:
Simple or Complex Aneurysm?
Test your coding knowledge. Determine how you would code this situation before looking... Read more
Modifier -59 Unlocks Separate Reimbursement for Hematoma Removal With Tumor Excision
Brain tumor excision (61510) and extra- or subdural hematoma evacuation (61312) are ... Read more
Part 1:
Understand Global Periods and Avoid a World of Hurt
So-called "global" periods which define a package of services or care associated with... Read more
Global Period Lengths Vary
Under Medicare guidelines as established by the Physician Fee Schedule, there are four... Read more
Reader Question:
New NPP Rules Affect Hospital,Not Office,E/Ms
Question: I've heard that CMS issued a memorandum regarding new nonphysician practit... Read more
Reader Question:
Medicare Wont Cover Stereotactic Cingulotomy
Question: What is stereotactic cingulotomy? How should I code for it? I can find no re... Read more
Reader Question:
Radiology Codes Are Bundled to Vertebroplasty
Question: What is the difference between percutaneous vertebroplasty (22520-22522) and... Read more
Reader Question:
Append Modifier -57 During Global Period Only
Question: My physician is adding modifier -57 to all E/M visits when he makes the deci... Read more
Reader Question:
Dont Charge Separately for Marcaine
Question: I am having difficulty getting paid for Marcaine. We use the HCPCS code J349... Read more
Reader Question:
Be Precise With ICD-9 Codes
Question: Are lumbar discogenic disease and lumbar disc disease coded 722.10 (Lumbar ... Read more
You Be the Coder:
Outpatient E/M Codes Are Appropriate for ED
Test your coding knowledge. Determine how you would code this situation before looking... Read more
Report All Services Involved for Blood-Brain Barrier Disruption Therapy
Blood-brain barrier disruption (BBBD) therapy allows for treatment of brai... Read more
2003 Injection Codes Improve Coding Clarity
CPT 2003 introduced four new somatic nerve block codes, eliminating the ne... Read more
Modifier -51 or -59? Solving the Mystery
Physicians, coders and carriers often have trouble distinguishing between modi... Read more
Reader Question:
Pseudoarthrosis Removal Is Often Included
Question: Which are the appropriate codes for removal of pseudoarthrosis... Read more
Reader Question:
Documentation and Modifiers Support Cosurgery
Question: How should I code for the transsphenoidal resection of pituitary... Read more
Reader Question:
Use 22318/22319 for Odontoid Screw
Question: Which code should I use to report placement of an anterior cervical ... Read more
Reader Question:
Intraoperative Monitoring
Question: During spinal surgery, we communicate with the intraoperative monitori... Read more
Reader Question:
Use 63056,Not 63030,for Far Lateral Diskectomy
Question: How should I bill for removing the right far lateral lumbar disk? Th... Read more
Reader Question:
Unlisted-Procedure Code the Only Choice for IDET
  Question: What is IDET? How should I code for it?Oregon SubscriberAn... Read more
You Be the Coder:
'Minimal' Diskectomy Included in 22554
Test your coding knowledge. Determine how you would code this situatio... Read more
CCI Strikes Again:
Watch for Bundling Edits When Reporting Nerve Blocks and Other Therapeutic Injections
The most recent update (version 9.0) of the national Correct Coding Initiative (CCI) i... Read more
Documentation Requirements Ease for Teaching Physicians
By Eric Sandham,CPC Teaching physicians will find documenting services they provide w... Read more
Expect Lower Payments in 2003
CMS has announced a reduction in the national Physician Fee Schedule conversion factor... Read more
News Brief:
OIG 2003 Work Plan Available on the Web
The U.S. Office of Inspector General (OIG) plans to focus on E/M services claims and,... Read more
Reader Question:
Dont Use ED Codes for In-Office Emergency
Question: Recently, an allergic patient presenting for evaluation of carpal tunnel syn... Read more
Reader Question:
Report Only Relevant Chronic Conditions
Question: Should I report a chronic condition if a patient presents for an acute conditi... Read more
Reader Question:
Dont Charge Extra for Interpreting Test Results
Question: May I report 76140-26 to read x-rays that a patient brings with him or her t... Read more
Reader Question:
Know When to Assign Signs and Symptoms
Question: Should we still report signs and symptoms if testing has confirmed a definit... Read more
Reader Question:
Fixation Points Determine Instrumentation Type
Question: If the surgeon places pedicle screws at L3 and L5 and connects a rod betwe... Read more
Reader Question:
Check Guidelines Before Reporting 69990
Question: Every time we report 69990, the carrier denies the claim, and each succeedin... Read more
You Be the Coder:
Use Modifier -58 for Return to OR
Question: Our surgeon performed a computed tomography (CT) guided stereotactic brain b... Read more
CPT 2003 Presents Some Important New Codes and Numerous Refinements
Along with important new codes to identify services previously reported with "unlist... Read more
Facet Injections, Part 2:
Medical Necessity Is Necessary for Optimum Reimbursement
Physicians billing facet joint injections (64470-64476) must observe strict utiliz... Read more
Gliadel Wafers Gain a Code
CPT 2003 has added a code to report separate placement of brain intracavitary chemot... Read more
CPT 2003 Recognizes Neuroendoscopic Procedures
For the first time, CPT officially recognizes neuro-endoscopic procedures with seven... Read more
Reader Question:
Match Place of Service and E/M Code
Question: One of our surgeons saw a patient in a nursing home. We reported 99244 with a ... Read more
Reader Question:
Determining the Value of Fixation
Question: Why does the fee schedule assign no relative value units (RVUs) to 22841? Sh... Read more
Reader Question:
No Modifiers Necessary for Bilateral Laminectomy
Question: May we append modifier -50 for bilateral lumbar laminectomy? Nevada Subsc... Read more
Reader Question:
Dont Charge Extra for Shaping Bone Grafts
Question: When placing bone grafts (for example, 20931), should I charge separately for ... Read more
Reader Question:
Use Unlisted-Procedure Code for FramelessStereotactic Surgery
Question: How should I report frameless stereotactic surgery? Texas Subscriber Answer:... Read more
You Be the Coder:
Gain Extra Compensation for Complications
Test your coding knowledge. Determine how you would code this situation befo... Read more
Available Years:  2003  2002  2001  2000