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Neurosurgery Coding Alert

CPT 2007 UPDATE ~ Learn These New Arthroplasty Coding Conventions Before Jan. 1
Lumbar gets a permanent code, but cervical still stuck in Category III CPT 2007 has hit t... Read more
CPT 2007 UPDATE ~ Report This New Code for Electrothermal Annuloplasty
Plus: Don't forget the new method for reporting closed skull fracture treatments While C... Read more
CPT 2007 UPDATE ~ Decide Patient Status as Easy as 1-2-3 With This Foolproof Flow Chart
Patient been to the office before? She might still be -new- for E/M claimsWhen a patient r... Read more
READER QUESTION ~ Identify Vertebroplasty Area Before Choosing Code
Question: One of our neurosurgeons performed a percutaneous vertebroplasty on two vertebra... Read more
READER QUESTION ~ Report Only Unrelated E/M Services During Global Period
Question: A month ago, a patient reported for a cervical laminotomy. The surgeon performed... Read more
READER QUESTION ~ Check for Pedicle Screws on PLIF Encounters
Question: Our neurosurgeon recently performed a posterior lumbar interbody fusion (PLIF) o... Read more
READER QUESTION ~ Code Each Lesion Treated With Gamma Knife Surgery
Question: A patient underwent gamma knife surgery, during which the neurosurgeon treated t... Read more
YOU BE THE CODER ~ Do You Need Modifiers for Partial Laminectomy Claims?
Question: The neurosurgeon performed a laminectomy with facetectomy/foraminotomy on the fi... Read more
Follow These 4 Steps to Successfully Code Skull Base Surgeries
Warning: Some surgeons don't use CPT terms to describe approach proceduresWhen a neurosurg... Read more
Physician Fee Schedule Update:
RVUs for High-Level E/Ms Could Increase
Greater payer scrutiny would certainly accompany higher RVUs In the recent 2007 proposed ... Read more
Reader Question ~ Before Coding Hospital Admission, Find Out Who Assumed Patient Care
Question: Our neurosurgeon treated a patient in the ED who had a severe headache and facia... Read more
Reader Question ~ Leave Modifiers Off Your Multiple Arthrodesis Claims
Question: The op notes for this claim state that the neurosurgeon performed arthrodesis at... Read more
Reader Question ~ Get Creative to Find NPI Applications
Question: I went to the Centers for Medicare & Medicaid Services Web site to apply for... Read more
Reader Question ~ NCCI Drives Most Payers' Policies on Surgical Microscope Payment
Question: One of our physicians performed a lumbar laminotomy on three interspaces. During... Read more
Reader Question ~ Get to Know E Codes
Question: I-ve never really understood E codes and when I should use them. Would you expla... Read more
Reader Question ~ Check for Second-Stage Procedure Before Coding 'Oberlin' Encounters
Question: What is an -Oberlin procedure- and how should I code for it?Wisconsin Subscriber... Read more
You Be the Coder ~ Are Double Craniotomies 2-Code Encounters?
Question: The neurosurgeon performed a left temporal craniotomy for evacuation of a subd... Read more
Physician Fee Schedule Update:
Proposed Fee Schedule Features $500 Boosts For Craniotomies
Neurosurgery may duck the harshest fee cutsThe Medicare Physician fee schedule for 2007 is... Read more
Has the NPP Executed A Plan of Care? Find Out Before Reporting Incident-To
Medicare is the only payer that consistently recognizes these services If you don't know ... Read more
Test Your NCCI Know-How With These Questions
Are you overusing modifier 59?National Correct Coding Initiative (NCCI) edits are part of ... Read more
Reader Question ~ Length of Treatment Determines Racz Procedure Coding
Question: I have an operative report that is quite puzzling. Notes indicate that the neuro... Read more
Reader Question ~ Take the Pain Out of Coding for Continuous Infusion Pumps
Question: Is there any way to code for nonepidural continuous infusion pump placements? Ou... Read more
Reader Question ~ Modifiers Matter When Reporting Substitute Physician Services
Question: One of the neurosurgeons in our group is expecting a baby and will be taking mat... Read more
You Be the Coder ~ Unlisted-Procedure Codes Not Sufficient For Arthroplasties
Question: Our neurosurgeon conducted a total disc arthroplasty on a patient. She also plac... Read more
News You Can Use:
Reclaim Thousands in Reimbursement Lost by the PLIF/Interbody Fusion Bundle
After protests against the edit, NCCI retroactively deletes the bundleYou can stop stressi... Read more
Don't Let Global Period Rules Complicate Your Post-Op Coding
Tip:  Not all payers count post-op services as part of the surgical packageIf you-re ... Read more
These Services Are Not Part Of The Global Surgical Package
If you're not reporting them, you're losing moneyIt can be hard to keep track of what you ... Read more
Automatically Rule Out 69990 And Forfeit Over $100 per Patient
Knowing payer guidelines is your key to operating-microscope reimbursementBefore you assig... Read more
READER QUESTIONS:
Ask Yourself--Decompression or Bony Lesion?
Question: One of our physicians performed a partial corpectomy at T-11 and a partial corpe... Read more
READER QUESTIONS:
Check Fee Schedule Before Bilateral Coding
Question: Can I report 63655 twice with a bilateral modifier when my physician performs th... Read more
READER QUESTIONS:
Weigh Your Deskectomy Options Carefully
Question: A neurosurgeon in my group documented that he performed an anterior lumbar diske... Read more
READER QUESTIONS:
Bone Up on Prolonged Service Coding
Question: Can you explain what prolonged service codes are for and when I might use them?I... Read more
READER QUESTIONS:
Don't Forego Compliance for Efficiency
Question: I-ve heard that some offices use physician signature stamps. Is this legal?Washi... Read more
You Be the Coder:
Coding Multiple Injections
Question: My surgeon gave a patient two epidural injections of a neurolytic substance. One... Read more
Laminectomy or Laminotomy? Documentation Is Your Key to Choosing the Right Code
Caution:  Avoid reporting both procedures at the same levelCPT has separate codes for... Read more
Make Critical Care Denials A Thing of the Past
Accurate timekeeping is crucial for precise codingIf the patient's condition isn't life-th... Read more
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Guarantee Correct Critical Care Coding With This Quick Reference Chart
Don't limit yourself t basic E/M codesMake reporting critical care easy with this simple c... Read more
News You Can Use:
Conquer Modifier 25 Audits With Clarified Guidelines
You can still report E/M services that go 'above and beyond' pre-op workWhile your modifie... Read more
READER QUESTIONS:
Let Harvest Procedure Guide Your Coding
Question: When my neurosurgeon harvests bone marrow for a graft, should I report 38220 for... Read more
READER QUESTIONS:
Sharpen Your Co-Surgeon Modifier Skills
Question: During the surgical portion of stereotactic brachytherapy, my neurosurgeon and r... Read more
READER QUESTIONS:
Decipher the Multiple Facet Joint Injection Rules
Question: The neurosurgeon administered two injections to block the median branch nerve in... Read more
READER QUESTIONS:
Check Out 0074T for Online Consults
Question: I-ve heard that we can charge insurance for our physician's online consultations... Read more
READER QUESTIONS:
Meet 3 Criteria Before Appending 78
Question: Three weeks after a patient underwent an anterior cervical diskectomy and fusion... Read more
You Be the Coder:
Pulse Generator Replacement
Question: When a neurosurgeon replaces an old VNS generator with a new generator, should I... Read more
ICD-9 2007 Update:
Manage Your Post-Op Pain Coding With Several New Diagnoses
Plus:  A new set of myelitis codes transforms spine-condition codingYou-ll no longer ... Read more
Coding Quiz:
Test Your Vertebroplasty, Kyphoplasty Knowledge
Find out in 5 minutes whether you're using 22520-22525 correctlyVertebroplasty and kyphopl... Read more
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Make Sure You're Ready for the October ICD-9 Changes Affecting Neurosurgery
Tack this chart to your wall to avoid confusion implementing 20+ relevant codes without a ... Read more
NCCI Update:
Join the Fight Against Version 12.1's Lumbar Arthrodesis Bundle
Coders await official stances from NASS and AAOSIf your neurosurgery practice is feeling t... Read more
Quiz Answers:
Pass the Vertebroplasty, Kyphoplasty Coding Test
Find out how you did answering the questions from the Coding QuizDid you conquer the codin... Read more
READER QUESTIONS:
Appeal 61548/61795 Denials
Question: Our physician did a sublabial transseptal transsphenoidal hypophysectomy for exc... Read more
READER QUESTIONS:
Count Prescriptions as Part of E/M
Question: My physician heard that there's a code we can bill and be paid on just for the p... Read more
READER QUESTIONS:
Look Beyond Span of Levels
Question: How should I determine whether a spinal fixation procedure is segmental or non-s... Read more
You Be the Coder:
Reporting Postoperative Consultations
Question: Can a consulting neurosurgeon charge for postoperative visits when another surge... Read more
Spine Surgery FAQs:
Experts Answer Your Top-3 Spinal Coding Questions
Learn when you should appeal multiple-procedure discounts If you don't know which spine s... Read more
Add Specificity by Appending Modifiers LT, RT and 50
Gain reimbursement for bilateral procedures with the correct modifier When a neurosurgeon... Read more
Reader Questions:
Don't Forget to Report Fluoroscopic Guidance
Question: My physician used a 22-gauge needle to inject 1% Xylocaine and 80 mg of Depo-Med... Read more
Reader Questions:
Look to Q6 for Locum Tenens
Question: My neurosurgery group is using a locum tenens to fill in at the hospital while o... Read more
Reader Questions:
Same-Practice Physicians Are 'Interchangeable'
Question: Should I report a consultation for an established patient (whom one of our physi... Read more
Reader Questions:
Choose a 'T' Code for Disk Arthroplasty
Question: I have a physician who performed a disk arthroplasty. He states that another phy... Read more
Reader Questions:
Ensure HPI Documentation
Question: If a nurse documents the history of present illness (HPI) in her notes and the p... Read more
Reader Questions:
Differentiate 'Mutually Exclusive' and 'Bundled'
Question: Would you explain what the differences are between mutually exclusive and -Colum... Read more
Reader Questions:
E/M Leads to Decision for Surgery
Question: A neurosurgeon I code for saw a patient in the hospital who presented with sever... Read more
Reader Questions:
Submit Electronic Claim First, Followed by Paper Claim
Question: We have difficulty filing paper claims for unlisted-procedure codes. Our payer s... Read more
You Be the Coder:
Double-Check When Surgeon Mentions Assistant
Question: My neurosurgeon said he had a general surgeon to -assist- on an anterior lumbar ... Read more
NCCI Update:
New Fusion Bundles Are Headed Your Way, Thanks to Version 12.1
Beware:  Modifier 22 may not help you capture additional reimbursementAs of April 1, ... Read more
NCCI Update:
Tackle New Laminoplasty Bundles by Level
Modifier indicator of '1' means you can break the bundleYou-re now faced with several new ... Read more
NCCI Update:
20660 Bundling Reflects Previous CPT Guidance
Watch out for 0077T and twist drill hole bundling, tooYou haven't been able to report the ... Read more
Reporting 61793 Only Once Per Session? CMS Says Think Again
Make sure you append the correct modifier, or you won't see reimbursementWhen a neurosurge... Read more
News You Can Use:
Don't Miss Out on Corrections For Spine Surgery Fee
CMS admits mistakes in fee schedule, but you'll have to do the legworkWith a little resear... Read more
Clarification
An article in the May 2006 issue of Neurosurgery Coding Alert, -New Fusion Bundles Are Hea... Read more
READER QUESTIONS:
Add On Cranial Bone Graft Placement Code
Question: I-m unclear on how to use code 61316. Would you explain it to me?Colorado Subscr... Read more
READER QUESTIONS:
CMS Saves You a Step on Early 2006 Claims
Question: Will I need to resubmit the claims I have submitted in 2006 to claim the correct... Read more
READER QUESTIONS:
Same-Day, Different-Specialty E/M Services OK
Question: Sometimes patients see two of our physicians on the same day. Is it ever appropr... Read more
READER QUESTIONS:
Choose 99050 for After-Hours Emergency
Question: I returned to the office at midnight to see a patient with a sudden and severe h... Read more
READER QUESTIONS:
Avoid Both Aneurysm and Skull-Base Codes
Question: Can I use the approach from the skull-base surgery section of the CPT manual and... Read more
READER QUESTIONS:
Control of Bleeding May Warrant Modifier 22
Question: I have an op report in which the neurosurgeon specifies that he performed -contr... Read more
You Be the Coder:
How Many Codes for Multilevel Diskectomies?
Question: A neurosurgeon in our group performed a diskectomy with nerve decompression and ... Read more
Stumped on How to Report Allografts? Experts Set the Record Straight
Tip: Type of graft determines 22851 vs. 20931 If conflicting information on how to rep... Read more
3 Is the Magic Number In Deciding New vs. Established
Tip: Scrutinize patient's relationship to physician before choosing an E/M code When you... Read more
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Here's Your Solution for Documenting Consultation Requests
This form will save you time, effort and denials Documentation--or lack thereof--can det... Read more
Reader Questions:
Documentation May Help Your Appeals
Question: An insurance company requested a refund on a payment it made for 69990 when we b... Read more
Reader Questions:
Don't Lose Out on Additional PLIF Reimbursement
Question: Is it appropriate for me to report both 22630 and 22612 for lumbar fusions that ... Read more
Reader Questions:
Reserve 99281-99285 for Hospital-Based Service
Question: A patient presenting for evaluation of carpal tunnel syndrome experienced anaphy... Read more
Reader Questions:
Does Dural Tear Warrant a Separate Code?
Question: Our neurosurgeon performed a laminectomy and repaired a dural tear at the same l... Read more
Reader Questions:
Marrow Aspiration Plus Spinal Fusion Equals 38220
Question: When he performs spinal fusions, my neurosurgeon often performs a bone marrow as... Read more
Reader Questions:
Ease Up on the Unlisted-Procedure Code for IDET
Question: Recently, I filed a claim for intradiskal electrothermal therapy (IDET) using un... Read more
Reader Questions:
Understand Teaching Physician Regulations
Question: My neurosurgeons work at a teaching hospital. What should I look for in the docu... Read more
You Be the Coder:
Count the Number of Stereotactic Markers
Question: Our neurosurgeon has been placing gold fiducial BBs for one of the radiation onc... Read more
Don't Lose Out Because of New Consultation Rules:
Our Experts Cover the Highs and Lows
Caution: CMS says you must avoid NPP split-visit billing with consultations If your neuro... Read more
The 3 R's of Consultations Become 4
Don't report a consultation code unless you have a documented reason For years you-ve kn... Read more
Tip of the Month:
Devise a Surgical Worksheet to Help Pick the Right Codes
Here's how to make your job easier without burdening your neurosurgeon Before you create ... Read more
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Use This Surgical Coding Form to Create One That Fits Your Needs
  A surgical coding worksheet can help you more quickly identify the procedures th... Read more
Reader Questions:
Review the Options for Removal, Insertion of Plates
Question: My physician removed an Atlantis plate and screws at C6-7, performed a routine a... Read more
Reader Questions:
Choose 61885, 61886 for Pulse Generator Placement
Question: How should I report a procedure in which my neurosurgeon implants subthalamic br... Read more
Reader Questions:
Insurers Won't Pay for Family Counseling
Question: Is there any way we can charge for a visit to discuss a patient's situation if t... Read more
Reader Questions:
Don't Avoid Same-Day Hospital Discharge, NF Admit
Question: When my neurosurgeon discharges a patient from a hospital and admits him to a nu... Read more
Reader Questions:
Halo Adjustment Won't Get You Additional Reimbursement
Question: What should I report when the neurosurgeon adjusts a cervical halo without admin... Read more
You Be the Coder:
Reporting E/M Services During Post-Op
Question: Our neurosurgeon performed a microvascular decompression (61458), and two weeks ... Read more
NCCI 12.0 Update:
Expect Denials If You Report Spine CT, Fluoroscopy With 22523-22524
New Category III codes for revision, removal or replacement of an artificial disc also tak... Read more
Don't Report Spine CT, Fluoroscopy With Kyphoplasty
Review the chart below to see what other important services of note NCCI 12.0 bundles with... Read more
Here's How to Keep Your E/M Modifiers Straight
Assign 57, not 25, for E/M prior to major surgical procedureIf your surgeon provides a bil... Read more
Call on 24 for Complication Evaluations--Maybe
Medicare will only allow return to OR with 78CPT rules allow you to report an E/M service ... Read more
READER QUESTIONS:
Get the Lowdown on Reductions and Laminectomies
Question: My surgeon did a reduction of kyphotic dislocation at L2; laminectomies at L1, L... Read more
READER QUESTIONS:
Don't Let Larvai Destroy Your Craniectomy Coding
Question: My physician performed a bilateral posterior fossa craniectomy with a C-1 lamine... Read more
READER QUESTIONS:
Nail Down the Cause of Ventriculomegaly Ex Vacuo
Question: My doctor documented that a patient has moderate ventriculomegaly, which is -ex ... Read more
READER QUESTIONS:
Osteotomy Means Use 22220 for Spur Removal
Question: A patient with difficulty swallowing presented to our practice. The neurosurgeon... Read more
READER QUESTIONS:
Limit 63276 to Posterior Side
Question: Can we report 63276 for each laminectomy level that the surgeon addresses? Also,... Read more
You Be the Coder:
61107 vs. 61210 Depends on Approach
Question: The physician determined that one of our patients had hydrocephalus and intraven... Read more
5 Tips Help Cement Your Percutaneous Vertebroplasty-Versus-Kyphoplasty Coding
Be sure to report radiological guidance to capture the reimbursement you deserveWith the a... Read more
Call on 25 for Same-Day Service and Significant E/M
Separate documentation must stress the E/M's distinct natureIf you expect reimbursement fr... Read more
Quick Quiz:
Get Up to Speed on the 2006 CPT Changes
Test yourself with these 6 questions about the edits, deletions and additions If you-r... Read more
READER QUESTIONS:
Let Location Guide Your Skull-Base Surgery Coding
Question: My doctor performed a skull-base surgery on a patient to remove a lesion. His op... Read more
READER QUESTIONS:
Communicate Hydrocephalus to Payers
Question: What is the appropriate diagnosis code for normal-pressure hydrocephalus (NPH)? ... Read more
READER QUESTIONS:
Report Services Regardless of Expected Payment
Question: Should we bill exactly the same group of codes to all payers, or can we submit t... Read more
READER QUESTIONS:
Neoplasm Makes the Difference With 63270, 63275
Question: My doctor states he did hemilaminectomy with resection of extradural mass locate... Read more
READER QUESTIONS:
Ancillary Staff May Perform History Review
Question: Does the neurosurgeon have to take a patient's history, or can a nurse or other ... Read more
You Be the Coder:
Stick With Level 5 When Appending Modifier 21
Question: Our surgeon performed a level-four E/M service on a new patient last week. The v... Read more
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