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Neurosurgery Coding Alert

63050/63051 Provide Easier Reporting for Open-Door Laminoplasty
3 new spinal codes and 1 skull procedure top the list of CPT 2005 changesAccording to our ... Read more
CPT 2005 Doesn't Deliver the Goods for Kyphoplasty
With no dedicated new code, you'll have to stick with S2362/S2363 or 22899 Neurosurgery p... Read more
3 New Imaging Codes to Watch
DEXA and PET scans open new diagnostic testing possibilities Neurosurgeons may have a new... Read more
Neurostim Codes Break Out Deep Brain Services
New codes 95978/95979 mean revisions for 95971-97973 When billing for electronic analysis... Read more
NCCI 10.3 Brings a Mixed Bag For Neurosurgeons
Fewer E/M billing opportunities are offset by instrumentation revisions Beginning Oct. 1,... Read more
CMS Puts the Squeeze on EMG Guidance With Botox Injections
For EMG with 64612-64614 and 64640, stick with 95870 only CMS has changed the rules for b... Read more
Aetna Allows Fluoro Guidance With Injections
If your neurosurgeon uses fluoroscopic guidance for needle placement during spinal or para... Read more
Reader Question:
Append -21 Only to Level-5 E/Ms
Question: Our surgeon performed a level-three E/M service on a new patient last week. The ... Read more
Reader Question:
Counseling Must Dominate as an E/M Criterion
Question: Our neurosurgeon saw a patient today for symptoms related to carpal tunnel syndr... Read more
Reader Question:
Consider Carefully Before Reporting 69990
Question: How should I report resection of a pineal tumor using microdissection? The surge... Read more
Reader Question:
Don't Forget -26 With MRA
Question: Which code describes MRA of the cranium?Nevada Subscriber Answer: CPT added tw... Read more
Reader Question:
62143 Describes Skull Flap Replacement
Question: The surgeon performed craniotomy and replaced the skull flap days later with tit... Read more
You Be The Coder:
Facet Injections Describe Neurolysis
Question: How should I code bilateral occipital neurolysis with cryoablation? Also, how sh... Read more
Shunt Coding Made Simple in Just 5 Steps
Look for proximal and terminal placement, experts say   If you can find out what ... Read more
Another Rejected Interp Claim? Here's Why
Don't bill for diagnostic test analysis if another physician already has Just because you... Read more
Red-Flag Alert:
CMS Puts Modifier -59 Claims Under Scrutiny
If op notes won't support a separate service, resist the temptation to unbundle If you're... Read more
READER QUESTION:
Discharge 99234 After Midnight
Question: We kept a patient in the hospital overnight for observation and decided the next... Read more
READER QUESTION:
Patient Provides an Autograft
Question: What's the difference between an autograft and an allograft? For example, how sh... Read more
READER QUESTION:
There's No Separate Charge for Suture Removal
Question: During a follow-up visit at the office, the surgeon removed several sutures from... Read more
READER QUESTION:
Go Unlisted for Cervical Vertebroplasty
Question: How should we report percutaneous vertebroplasty of a cervical vertebra? CPT con... Read more
READER QUESTION:
61793 Describes Gamma Knife Procedure
Question: How should I report the use of gamma knife for lesion removal?Oklahoma Subscribe... Read more
READER QUESTION:
Include Ventricular Drain in Craniotomy
Question: What is the correct code to describe placement of a drain for intraoperative ven... Read more
READER QUESTION:
For Distinct Arthrodesis and Laminectomy, Apply -59
Question: Our insurer is denying 22630 and 63047 during the same session. Why?Nevada Subsc... Read more
You Be the Coder:
How Should We Report Infraorbital Block?
Question: One of our surgeons performed an infraorbital nerve block. What is the correct C... Read more
Want the Key to Unlock Workers' Comp Pay? Look to E Codes
Insurers often won't pay your WC claim without information about the accident or disease's... Read more
Select 99455-99456, Not E/M Codes, for WC EvaluationsSelect 99455-99456, Not E/M Codes, for WC Evaluations
If your surgeon evaluates a patient for a workers' compensation claim, you should tu... Read more
OIG Alert:
Make Sure That Consult's Not a Transfer of Care (or Vice Versa)
Choosing an office visit when a consult is appropriate means lost revenue To avoid being ... Read more
Consult or Not? Take Our Quiz And Test Your Savvy
Are you still not sure what separates a consult from a transfer of care or referral? Or do... Read more
Information Update:
Drug Pumps and Baclofen
When reporting refills for baclofen, use 95990/95991 When reporting drug refills of baclo... Read more
Reader Questions:
Think of 'Segments' as Bony Portion of Spine
Question: Codes 63045-63047 refer to vertebral segments. Does this identify a single verte... Read more
Reader Questions:
New Patient Not Based on Creating Medical Record
Question: When a patient presents to the office for the first time after one of our surgeo... Read more
Reader Questions:
Include Halo Adjustment in Global
Question: Is there a code for adjusting a cervical halo without anesthesia?Illinois Subscr... Read more
Reader Questions:
For Most Payers, You No Longer Need -51
Question: I notice CPT includes a modifier (-51) for "multiple procedures." I never append... Read more
Reader Questions:
Skip Anesthesia Codes for Conscious Sedation
Question: Especially when dealing with young children, our surgeon will administer conscio... Read more
You Be the Coder:
Two Separate Approaches = Two Aneurysms
Question: The surgeon performed a craniotomy to treat two aneurysms, one ruptured and one ... Read more
3 Tips Ensure Proper Reimbursement for Trigger Point Injections
Be sure to limit your claims to one unit of either 20552 or 20553 per encounter You'll re... Read more
Modifiers -58, -78 and -79:
How to Choose the Right One
Decide first if the procedure is related to or a complication of a previous surgery Can... Read more
Don't Risk Losing Thousands on Subsequent Hospital Care
Answer 3 questions to strengthen your documentation Are you worried that your surgeon is... Read more
Are You Reporting 64999 for IDEA? It's Time for a Change
Choose category III code over unlisted-procedure code July 1 has come and gone - which mea... Read more
Reader Questions:
Include 'Mini-Mental' Exams in E/M
 Question: What is the proper code to report a mini-mental exam? I've heard that we s... Read more
Reader Questions:
You Can Use 61517 for Gliadel Wafers
 Question: What can you tell me about Gliadel Wafers? Is there a code to describe the... Read more
Reader Questions:
Pair 64472 With 64470 for Additional Levels
Question: Our surgeon performed an intra-articular joint injection in the cervical re... Read more
Reader Questions:
Don't Use Endoscopic Codes as 'Add-ons'
Question: Are the endoscopic codes (62161-62165) replacement codes or add-on codes? For in... Read more
Reader Questions:
Append -78 for Postoperative Shunt Irrigation
Question: The surgeon placed a ventricular shunt to drain excess cerebrospinal fluid (6222... Read more
You Be the Coder:
Don't Expect Additional Payment for Laser
Question: May I charge extra for use of a CO2 laser during diskectomy? Fo... Read more
A Single Method Won't Work When You Report Multilevel Spinal Surgeries
3 case studies illustrate the unique coding requirements of laminotomy, laminectomy a... Read more
6 Points Every Coder Must Know About NCCI
Learn when it's OK to unbundle and increase your reimbursement potential If you're report... Read more
Our Experts Respond:
What Makes a Postoperative Complication 'Unrelated'?
When deciding whether you should separately report postoperative wound care during the glo... Read more
Reader Question:
Drug and Pump Are Separate for Baclofen
Question: Which code(s) are appropriate to report intrathecal baclofen? Michigan Subscr... Read more
Reader Question:
No More Starred Procedures Means More Modifiers
Question: What's the practical significance of losing the "starred designation" in CPT 2... Read more
Reader Question:
Report Botox Once per Procedure
Question: My surgeon performed a peripheral nerve branch chemodenervation with Botox in ... Read more
Reader Question:
You Can Appeal Modifier -25 Denials
Question: Whenever I use modifier -25 on an E/M service with a procedure code on the sam... Read more
Reader Question:
Discontinued Lumbar Puncture? Append -53
Question: During a lumbar puncture, the patient's left leg became numb, and he had sever... Read more
Reader Question:
For Computer-Assisted Planning, Access 61795
Question: Does 61795 include planning before surgery or intraoperative navigation? Texa... Read more
You Be the Coder:
Include Drain Placement in Global Fee
Question: Our neurosurgeon often places a Blake drain during spinal surgery for postoper... Read more
To Make the Most of ACDF Claims, Take a One-Code-at-a-Time Approach
You must document every step to gain full payment for this multi-code procedure To report... Read more
Save Payments by Spending Time to Append -51 Correctly
If your payer doesn't use software that sorts procedures according to their assigned relat... Read more
Are You Reporting Reduced Services Correctly?
Knowing why your surgeon halted the procedure matters for modifiers -52/-53 When a surgeo... Read more
2005 ICD-9 Codes Offer Nothing New for Neurosurgeons
Changes to ICD-9 for 2005 will have little effect on neurosurgery practices, and offer no ... Read more
If You're Cutting Fees for -52 and -53,You're Losing Out
When you append modifier -52 or -53 to a claim, you want to tell the payer why. Include a ... Read more
Debunk the 99211 Myth - It's Not Just for Nurses
If a visit warrants 99211,you can recoup an additional $20 or more Surgeons and other per... Read more
Reader Question:
99291 Reimburses Better Than 99215
Question: Are there any advantages to choosing critical care codes rather than standard ... Read more
Reader Question:
Don't Treat NOS and NEC the Same
Question: What do "NEC" and "NOS" mean in diagnosis coding? How should I choose between ... Read more
Reader Question:
Branch Order Determines Nerve Destruction Codes
Question: How should I report the destruction of three separate branches (supraorbital, ... Read more
Reader Question:
Include Control of Bleeding in Primary Procedure
Question: During surgery our surgeon dictated that she performed "control of bleedi... Read more
You Be the Coder:
Do Consults Have Time Limits?
Question: If I perform an office consultation on a patient, how much time must elapse be... Read more
2 Questions Help You Report Postoperative Infections for the Best Results
Earn an extra $80 or more per claim by knowing when NOT to follow CMS guidelines  If... Read more
Our Clip-and-Save Flow Chart Eases Your Post-Op Infection Coding
When neurosurgeons treat postoperative infections during global periods, you should ask th... Read more
NCCI 10.1 Could Cost You Cash
16 testing codes bundled into scores of spinal surgery procedures  When your surgeo... Read more
3 Tips to Collect $75-$100 per Hospital Discharge Claim
Air-tight documentation will guarantee your 99238-99239 claims Surgeons report hospital d... Read more
Reader Question:
Removal/Reinsertion Best Describes Replacement
Question: How can I report C7 bilateral screw removal followed by replacement with rescue ... Read more
Reader Question:
Same-Day Consult and Procedure? Use -25
Question: Our surgeon recently performed a consult with findings that necessitated a spina... Read more
Reader Question:
Choose 99341 Series for Home Visits
Question: One of our surgeons visits patients at their homes occasionally to evaluate hern... Read more
Reader Question:
If Patient Switches to Your Office, Use 99201-99205
Question: When my surgeon covers for another local private-practice physician, I code the ... Read more
Reader Question:
You May Bill WC for Nonwork-Related Activities
Question: The surgeon saw a patient as a follow-up for a workers' compensation claim. He i... Read more
Reader Question:
Patient's Status Drives E/M Coding
Question: During an office visit, our surgeon performed an expanded problem-focused histor... Read more
Reader Question:
You Can Equate Selective Nerve Root and Epidural Injections
Question: What is the correct code for a selective nerve root injection?Nebraska Subscribe... Read more
Reader Question:
Single Nerve = Single Code for Nerve Destruction
Question: Our surgeon performed three cryodenervations of the 11th intercostal nerve on th... Read more
You Be The Coder:
Laminectomy With Dural Tear May Warrant -22
Question: If our neurosurgeon performs a laminectomy and repairs a dural tear at the same ... Read more
Separately Report Grafting During Arthrodesis and Collect an Additional $200
You needn't worry about NCCI Edits with most bone graft/spinal fusion combinations ... Read more
Recoup the Cash You Deserve With Modifiers -LT, -RT and -50
Realize $430 more for bilateral laminotomy with the correct modifier You're not alone if ... Read more
Spinal Bone Graft Codes at a Glance
When reporting bone grafts with spinal fusions (22548-22812) and/or instrumentation (22840... Read more
Create a Win/Win Situation With After-Hours Codes
Gain an extra $50 for urgent office visits and still save the payer money Medicare payers... Read more
Reader Question - Same-Day Observation/Discharge:
99234-99236
Question: A patient presented to the emergency department complaining of dizziness and nau... Read more
Reader Question:
Fee Schedule Can Give You Global Period Info
Question: How can I find the length of postoperative global periods for various procedures... Read more
Reader Question:
Use the 'Units' Box for Multiples of a Single Code
Question: When reporting multiple units of a single procedure, should I use the "units" bo... Read more
Reader Question:
Don't Expect Payment if Patient Isn't Present
Question: Can we bill an office visit (99211-99215) for a consult with a family member to ... Read more
Reader Question:
NCCI Bundles Steroid Injection/Hemilaminotomy
Question: The surgeon performed an L4-5 hemilaminotomy and diskectomy with an epidural ste... Read more
You Be The Coder:
How Many Units of Fluoroscopic Guidance?
Question: May I report multiple units of fluoroscopic guidance when administering facet bl... Read more
5 Ways to Prop Up Your Instrumentation Claims
Mastering terms and modifiers makes the differenceIf you're bewildered by the mysteries of... Read more
4 Pointers Make 'Add-on' Codes Easy
CPT is full of "add-on" codes, from minor and major surgical procedures to E/M services, b... Read more
3 Important Steps for Co-Surgery Reimbursement
Success requires modifier -62 and physician-to-physician cooperation When reporting co-sur... Read more
Avoid the Modifier -62/-80 Mix-up
When trying to decide between modifiers -62 (Two surgeons) and -80 (Assistant surgeon) whe... Read more
Reader Question:
Use Initial Inpatient Consults for Nursing Homes
Question: Which codes should I use when the physician has been called into the nursing hom... Read more
Reader Question:
Foraminotomy and Facetectomy Go Hand-in-Hand
Question: Our surgeon performed a laminectomy with bilateral foraminotomies with decompres... Read more
Reader Question:
New Kyphoplasty Codes Don't Guarantee Payment
Question: I have heard that HCPCS was releasing a new code for kyphoplasty this year. What... Read more
Reader Question:
Try to Avoid 'Generalized' Weakness
Question: Which ICD-9 code should I use for progressive generalized weakness?Alaska Subscr... Read more
Reader Question:
Count Global Days With Modifiers
Question: I understand that modifier -57 is appropriate when a physician makes a decision ... Read more
You Be The Coder:
New Codes on the Way for IDEA
Question: How can I report intradiscal electrothermal annuloplasty (IDEA)? Nevada Subscrib... Read more
6 Tips Help You Report Lysis of Spinal Adhesions Correctly
Hint: Counting days is the key, coding experts say Revisions to CPT in recent years allow ... Read more
Stop Forfeiting Your CPO Payments
Careful documentation could earn you an extra $80Don't let carriers undervalue your physic... Read more
Get to Know Your CPO Codes
You should choose your care plan oversight (CPO) codes according to the payer you are deal... Read more
CPO Do's and Don'ts
If you're looking for "just the facts," here's a quick list of "Do's and Don'ts" to make y... Read more
Reader Question:
Look to Unlisted-Procedure Code for EDAS
Question: What is the proper code for encephaloduroarteriosynangiosis with a diagnosis of ... Read more
Reader Question:
Include Simple Dural Repair
Question: If the surgeon performs a laminectomy and must repair a dural tear at the same l... Read more
Reader Question:
See Modifier -55, Think Postoperative Care
Question: Our neurosurgeon recently took over the postoperative care of another surgeon's ... Read more
Reader Question:
Modifier -62 Is OK for 22855
Question: My surgeon worked with an orthopedic surgeon during removal of anterior spinal i... Read more
Reader Question:
How Do 'New' and 'Established' Affect Consults?
Question: May I bill a consult for an established patient (last seen two years ago) seen b... Read more
Reader Question:
Co-Management May Warrant Consult
Question: Can I report a consultation if the neurosurgeon co-manages a patient's care?Sout... Read more
You Be The Coder - What's the Code for Halo Adjustment?
Question: Is there a code for adjusting a cervical halo without using anesthesia, or would... Read more
No Code? No Problem:
Here's How to Handle Those Pesky 'Unlisted-Procedure' Claims
If you've ever filed a claim using an unlisted-procedure code, you know how much effort is... Read more
Identify Critical Care and Receive a Vital Payment Boost
Many coders get nervous when claiming critical care. CPT devotes extensive explanatory tex... Read more
Quick Quiz:
Critical Care
No one wants to go to the trouble of filing a claim only to have it rejected, especially o... Read more
Have You Gone Electronic?
CMS final rule mandates e-claims Have you begun submitting your Medicare claims electroni... Read more
CMS Announces 2004 Payment Factor of 37.3374
As promised, CMS has delivered a 1.5 percent increase in the Physician Fee Schedule for 20... Read more
Reader Question:
Ask Private Payers for a -59 Alternative
Question: A number of our private payers observe National Correct Coding Initiative (NCCI)... Read more
Reader Question:
Treat 'Initial' and 'Redo' Levels Independently
Question: How should I code when the surgeon performs a lumbar decompression (63047), but ... Read more
Reader Question:
Spinal Instability Calls for Instrumentation
Question: Our surgeon recently performed a laminectomy for biopsy and excision of an intra... Read more
Reader Question:
Choose 35301 for Endarterectomy
Question: What are the proper codes for carotid endarterectomy? Washington, D.C., Subscrib... Read more
Reader Question:
Pay Close Attention to LMRP for Facet Joints
Question: Our Medicare payer is rejecting all claims for facet joint injections. Any idea ... Read more
You Be the Coder:
Interrupted Lumbar Puncture
Question: A physician attempted a lumbar puncture on a patient. During the procedure, the ... Read more
CPT 2004:
Get the Latest News on Nerve Destruction, Extracavitary Surgery and More
For 2004, CPT brings a number of welcome code additions, as well as a few clarifications a... Read more
Look for Trigger Point Code Changes in 2004
New descriptors help you code multiple injections For 2004, CPT has slightly refined the ... Read more
There Are No Stars to Guide You in 2004
You may need to change the way you report starred procedures to private payers beginning J... Read more
Fee Schedule Update:
Legislation Offers 1.5 Percent Payment Increase for 2004
Once again for 2004, Congress has passed legislation that reverses a threatened reduction ... Read more
Reader Question:
Reoperative Laminectomy Equals Postlaminectomy
Question: What is proper coding for repair of postlaminectomy syndrome?Arkansas Subscriber... Read more
Reader Question:
Document Unrelated Multiple Visits
Question: What are the rules for coding two visits by the same patient in the same day? Re... Read more
Reader Question:
Report 99255 Just Once Daily
Question: If I report 99255 more than once for the same patient on different days, Medicar... Read more
Reader Question:
Unlisted-Procedure Code for 'Open-Door'
Question: What is the appropriate code for open-door laminoplasty? Should I report this as... Read more
Reader Question:
Report Initial Hospital Care for Admits Only
Question: Our neurosurgeon was recently called into the hospital to take over the care o... Read more
Reader Question:
Medicare Won't Recognize 'After Hours'
Question: A Medicare patient knocked on the door on a Friday when the office was closed. H... Read more
Reader Question:
Select 99220 and 99217 for Multiday Observation
Question: Our surgeon treated a patient in the emergency department and admitted the patie... Read more
You Be the Coder:
Modifier -22 or Unlisted-Procedure Code?
Question: Our surgeon asks us to report procedures that take extra time and effort with an... Read more
Available Years:  2004  2003  2002  2001  2000