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Neurosurgery Coding Alert

CPT 2009:
Total Disc Arthroplasties Gain Industry Acceptance With Regular CPT Codes
Watch out: Overlooking these neurosurgery revisions could cost you big in 2009. When your... Read more
Capture Arthroplasty With Easier 1-Code Method
These notes bundle 4 services. You-ll have a streamlined way to report cervical disc re... Read more
CPT 2009:
Toss Modifier 21 Out and Go to +99354-+99359 Instead
See why 30 minutes more than usual is the magic requirement. If your neurosurgeon spe... Read more
News You Can Use:
Mark Your Calendar: ICD-10 Could Hit in 2011
The new code set will quadruple the diagnostic codes you can choose from. You-re busy u... Read more
Reader Questions:
Does Nerve Pedicle Transfer Always = Oberlin?
Question: Are all nerve pedicle transfers considered Oberlin procedures? Georgia Subscr... Read more
Reader Questions:
How to Code 2 Sides of VP Shunt Replacements
Question: The neurosurgeon removed a left-sided ventriculoperitoneal (VP) shunt and plac... Read more
Reader Questions:
Include Paraspinal Injection With PLIF Procedures
Question: I have a neurosurgeon who injected 80 mg of Depo-Medrol and 10 cc Marcaine int... Read more
Reader Questions:
Check Descriptor Before Applying 63005
Question: Patient presented with symptoms that resulted in a L-MRI which revealed an ext... Read more
Reader Questions:
Add Two Codes Per Hour of IOM, Electromyography
Question: My neurosurgeon performs intraoperative monitoring for a pedicle surgery. He s... Read more
Reader Questions:
Do This for Anterior Cervical Osteophytic Spur Removal
Question: A patient with difficulty swallowing presented to our practice. The neurosurge... Read more
You Be the Coder:
Pick Up This Continuous Infusion Pump Advice
Pick Up This Continuous Infusion Pump Advice Question: Our neurosurgeon occasionally us... Read more
Withstand Microsurgical Techniques Scrutiny by Following 3 Simple Steps
Careful application could yield your practice an extra $120. You can capture an additio... Read more
Take Guesswork Out of Coding Teaching Physician Services
Here's what modifier to use for the primary-care exception. You can ensure that your ne... Read more
Coding Quiz:
Take This Brain Tumor Excision, Hematoma Evacuation Challenge
Find out when you can circumvent CCI bundles. If you think you-re limited to the brain ... Read more
Coding Quiz Answers:
Modifiers Can Shatter Excision, Evacuation Bundles
Bonus: Here's how anatomical modifiers can bolster your claim. Adding modifiers such as... Read more
Reader Questions:
Count Reviewing Records as Part of E/M
Question: My physician wants to bill for the time she spends reviewing medical records f... Read more
Reader Questions:
Coding 'Oberlin' Procedure? Check for This
Question: What is an "Oberlin procedure" and how should I code for it? Wisconsin Subscr... Read more
Reader Questions:
No Patient There? Don't Expect Payment
Question: Should we bill an office visit (99211-99215) for a consult with a family membe... Read more
Reader Questions:
Surgeon Can Admit Patient From the Office
Question: If our surgeon sees a patient in the office, and sends that patient immediatel... Read more
Reader Questions:
Treat TLIF as Posterior Fusion
Question: Which CPT code describes TLIF? Pennsylvania Subscriber Answer: For a trans... Read more
You Be the Coder:
Get to the Root of "LNR"
Question: What codes should I use for lumbar paravertebral facet nerve injection and a l... Read more
Part 2:
3 Final Steps Assure Successful Spinal Neurostimulator Coding
Pay attention to frequency of programming services If a surgeon moves forward with perm... Read more
Answer 'Yes' 3 Times, Apply Modifier 78
Return to the OR is a must If you want to be sure when you should apply modifier 78 -- ... Read more
Consider These Alternatives to Modifier 78
If the service you wish to report doesn't quite meet the standards for applying modifier 7... Read more
Reader Questions:
22206-22208 Describe 3-Column Osteotomy
Question: Our surgeon documented transpedicular three-column osteotomy via posterior app... Read more
Reader Questions:
Documentation Distinguishes Consult
Question: What's the difference between a consult and a referral? How, for instance, wou... Read more
Reader Questions:
Query Your Payer for Fiducial Screws
Question: How should I report placement of fiducial screws prior to surgery? I-ve been t... Read more
Reader Questions:
Laminoplasty Deserves Dedicated Codes
Question: How does cervical laminoplasty differ from laminectomy? What should I look for... Read more
You Be the Coder:
When Can You Report Presurgical H&P?
Question: Can we charge for a preoperative visit when the surgeon performs a history and... Read more
Part 1:
One-Step-at-a-Time Ensures Successful Spinal Stimulation Claims
Consider programming part of implantation Implanting spinal neurostimulators involves s... Read more
What Qualifies as 'More Extensive?' Find Out Now
If same condition prompts initial and follow-up procedures, 58 applies The AMA revised ... Read more
Use Caution When Device Maker Offers to Appeal for You
Keep control of your own claims, experts advise Device manufacturers may sometimes offe... Read more
Reader Questions:
TruFUSE Describes Posterior Fusion
Question: How would we bill for a lumbar TruFUSE technique facet fusion? Is this 22612/2... Read more
Reader Questions:
Avoid Cat. I Code for Autologous Plasma Grafts
Question: Is there a CPT code for autologous platelet rich plasma grafts that our surgeo... Read more
Reader Questions:
Separate Session = Billable Control of Bleeding
Question: I understand that you should include control of bleeding during a surgical pro... Read more
Reader Questions:
1 Code Represents 3+ Injections
Question: When a physician injects more than three muscles on each side of the upper bac... Read more
Reader Questions:
Report Fluoro Codes With Caution
Question: Under what circumstances may our surgeon code for fluoroscopic guidance? Illi... Read more
Reader Questions:
Code Per Lesion for Gamma Knife
Question: If the surgeon treats multiple lesions (in this particular case, two different... Read more
Reader Questions:
22 Might Be Best for Multiple Aneurysms
Question: How should I code if the surgeon clips multiple aneurysms during the same cran... Read more
Reader Questions:
Collect for 22214, Not 0171T
Question: If the surgeon performs a lumbar spine osteotomy (22214) and places an X-STOP ... Read more
You Be the Coder:
Which Code for Flap Placement?
Question: Which code is appropriate if the surgeon places a bone flap in a subcutaneous ... Read more
The Difference Between Nerve Block and Destruction May Be Greater Than You Think
Report only destruction with same session/location block When coding for facet joint in... Read more
CERT Reveals Poor Neurosurgery Coding Results
Better documentation up front can prevent expensive mistakes Alert your surgeon: Insuff... Read more
Watch Out for Fee Reductions With Spinal Add-Ons
Don't let a CMS typo sabotage deserved reimbursement A simple mistake in the Medicare p... Read more
Watch for Co-Surgery on Anterior Arthrodesis
Coordinate surgeon claims or chance missed reimbursement When coding claims for spinal ... Read more
Reader Questions:
Re-Exploration Period Begins After 90 Days
Question: I-ve heard that when the previous spinal surgery is 90 days to one year out, w... Read more
Reader Questions:
Bone Biopsy Is Bundled to Kyphoplasty
Question: May we report bone biopsy separately with kyphoplasty? We-ve begun to receive ... Read more
Reader Questions:
Limit 61558 to Once Per Session
Question: Is it appropriate to report 61558 more than once per session, perhaps by apply... Read more
Reader Questions:
Tong Placement Is Incidental to Spinal Surgery
Question: Can our surgeon gain separate payment for placement of Gardner-Wells tongs to ... Read more
Reader Questions:
Be Precise for Pain Dx
Question: I often see physicians document -chronic pain- as a diagnosis. Is there a better... Read more
Reader Questions:
ICD-9 Provides Dural Tear Dx
Question: What is the ICD-9 Code for a dural tear that occurs during surgery? Tenness... Read more
You Be the Coder:
Which Code Best Describes Cyst Removal?
Question: Our surgeon performed "L4-5 foraminotomy and removal of synovial cyst." The cy... Read more
3 Questions Reveal Your Ideal Arthrodesis Code
Don't overlook separately reportable services If you approach arthrodesis claims with d... Read more
Choose a Single Primary Level for Cross-Region Arthrodesis
Select the highest RVU code as the initial level When the surgeon performs arthrodesis ... Read more
Now's the Time to Review Your Revalidation Process
Danger: Medicare can pull billing privileges for noncompliance If your practice bills M... Read more
11 Must-Know Points to Assess Your Revalidation Compliance
If you can't answer -yes- each time, it's time for a change 1. Is the provider's Medica... Read more
CCI Quick Update:
X-STOP Bundles Biopsy, Excisions
The latest national Correct Coding Initiative (CCI), version 14.1, bundles several codes i... Read more
Reader Questions:
Medicare Assigns No Value to 20936, 20930
Question: Our local Medicare carrier consistently refuses to pay for local autografts (2... Read more
Reader Questions:
Discectomy May Be Separate With Arthrodesis
Question: If my surgeon performs extensive discectomy during anterior interbody arthrode... Read more
You Be the Coder:
Are Chemo Disc Placements Separate?
Question: Is there a separate code to describe placement of Gliadel wafers, or must I us... Read more
Distinguish Spinal '-ectomies' for Easy Coding:
Here's How
Hint: Purpose of the surgery can help you narrow your selection Similarities among vert... Read more
New ABN Will Free You From NEMB Confusion
Update now if you-re not already using the revised form If you never quite understood w... Read more
IOM 101:
There's More to It Than 95920
Tracking time, reporting baselines present the real challenge You-re not alone if you f... Read more
Reader Questions:
Halo Removal Included in Placement
Question: May we report 20665 for removal of a stereotactic halo? Ohio Subscriber An... Read more
Reader Questions:
Bilateral Laminectomy Doesn't Require Modifier 50
Question: Should we append modifier 50 for a bilateral lumbar laminectomy? Washington S... Read more
Reader Questions:
Pain Pump May Be Separate
Question: How should I report pain pump application following surgery? North Carolina S... Read more
Reader Questions:
Snag Separate PLIF and Laminectomy Pay
Question: My surgeon argues that we should be able to report a laminectomy (63047) in ad... Read more
Reader Questions:
'Simple' Denotes Size or Complexity for Aneurysm
Question: What differentiates a "simple" from a "complex" intracranial aneurysm? Missis... Read more
You Be the Coder:
Base Block Coding on Levels, Not Nerves
Question: Our surgeon documented that he administered a nerve block to the left side of ... Read more
If You're Treating 61793 as a Once-and-Done Code, You're Missing Out
Warning: Watch for bundling edits with component services When reporting stereotactic r... Read more
Know When to Treat 'Separate Procedures' Separately
Turn to CCI for guidance if you-re in doubt about a bundle The true meaning of a "separ... Read more
5 Steps to Master Assistant-at-Surgery Modifiers
Medicare prohibits NPPs from using modifier 80 Faced with the choice of three CPT modif... Read more
Reader Questions:
Brush Up on Your CCI Lingo
Question: I-m familiar with CCI edits, but what does the term "mutually exclusive" mean ... Read more
Reader Questions:
Use Paper as a Backup for Modifier 22 Claims
Question: Must I always file modifier 22 claims manually? Is there an easier and faster ... Read more
Reader Questions:
Endoscopy Includes Access
Question: If our surgeon uses a neuroendoscope, for instance for dissection of adhesions... Read more
Reader Questions:
2 Surgeons, 2 Procedures = Separate Coding
Question: Our neurosurgeon performs craniofacial surgeries with a plastic surgeon. The p... Read more
Reader Questions:
Skip Multiple Fluoroscopy Units
Question: When the surgeon uses fluoroscopy for more than an hour (for instance, during ... Read more
Reader Questions:
Laminectomy/Biopsy Code Depends on Path Results
Question: Our surgeon performed an L4, L5, S1 laminectomy to take several biopsies. What... Read more
You Be the Coder:
Which Code Describes Silastic Graft?
Question: The surgeon removed a subdural hematoma via craniectomy. Rather than reattach ... Read more
Get a Head Start on Cranial Reconstructions -- Here's How
Warning: Watch out for craniotomy/cranioplasty bundles When reporting cranial reconstru... Read more
Make Short Work of Cranioplasty/Craniotomy Bundles
Rather than wade through thousands of CCI edits, look to this easy-to-use chart to find wh... Read more
Follow 3 Tips for Modifier 22 Success Every Time
Provide a comparison to rationalize additional reimbursement You probably already know ... Read more
Be Specific When Defending an 'Unusual' Claim
To argue more effectively that a claim was truly unusual -- and therefore deserving of mod... Read more
Modifier 22 Do's and Don'ts
Follow this quick checklist of do's and don-ts before sending your modifier 22 (Increased ... Read more
Reader Questions:
Be Location-Specific for Pain Dx
Question: How should I assign a diagnosis if the patient's primary complaint is "back pa... Read more
Reader Questions:
Number of Vertebrae, Fusions Isn't Equal
Question: If the surgeon fuses vertebrae L2 through L5 posteriorly, how many units of ar... Read more
Reader Questions:
Don't Make Re-Exploration Harder Than It Is
Question: How should I report a right L4-L5 "redo" laminectomy, foraminotomy and discect... Read more
Reader Questions:
Test Interpretations Aren't Always Separate
Question: My surgeon and I have an ongoing debate about diagnostic testing, such as CT s... Read more
You Be the Coder:
Can You Code Tongs With Laminectomy?
Question: May we report 20660 separately for use of tongs when performing cervical lamin... Read more
Capture All the Steps When Your Surgeon Uses Cranial Bone Flaps:
Here's How
Multiple sessions within 90 days? Call on 1 modifier to make the difference Pay attentio... Read more
Unravel the 'Complications' Complication -- for Good
For Medicare, you must meet 2 conditions for correct billing Medicare treats payment for ... Read more
What's a 'Complication'? CMS and CPT Differ
Under the concept of a global surgical package, payers bundle or include payment for servi... Read more
Don't Expect Total Reimbursement With 78
When you-re filing claims with modifier 78, don't expect to receive the full fee schedule ... Read more
Make Your Dural Repair Claims Water-Tight
Grafting hints at a separate code If you assume repair of the dura is an unreportable s... Read more
Reader Questions:
Each Additional' Describes Bilateral Laminotomy
Question: If the surgeon performs a right laminotomy at L4-L5 and a left laminotomy at L... Read more
Reader Questions:
Look for Best I&D Option
Question: How should I report incision and drainage of a postoperative wound due to infe... Read more
Reader Questions:
69990 Allowed With Dural Repair
Question: Can I report 69990 for using the operating microscope with craniotomy for dura... Read more
You Be the Coder:
Can You Report 64470 per Injection?
Question: Our neurosurgeon administered a facet block via the patient's medial branch ne... Read more
Answer 3 Questions for Spinal Bone Grafts
Not all spinal grafting codes will reimburse separatelyFail-proof spinal bone graft coding... Read more
AMA Says Dowels Are an Exception
In the February 2005 CPT Assistant, the American Medical Association clarified that the on... Read more
Spinal Bone Graft Quick-Decision Q&A
Question 1: Was it an autograft or allograft?Autograft: Go to Question 2Allograft: Go to Q... Read more
Multiple Spinal Grafts May Mean Multiple Codes
Graft type matters more than numberOn occasion, such as during a complicated, multi-level ... Read more
Make Add-On Code Claims Effortless
Here's what -modifier 51 exempt- really means for your bottom lineAnytime you report an -a... Read more
READER QUESTIONS:
Consult Applies to 1 Provider Only
Question: I know that a nonphysician practitioner and a surgeon can -share- an E/M visit, ... Read more
READER QUESTIONS:
Extensive Laminectomy May Be Separate
Question: May we report arthrodesis (22630) and laminectomy (63047) during the same sessio... Read more
READER QUESTIONS:
Laminotomy Includes Endo Assist
Question: How should I code if the surgeon uses endoscopic assist during lumbar laminotomy... Read more
READER QUESTIONS:
You Can't Unbundle Access From Fusion
Question: How should I code when a general surgeon performs the surgical exposure for a sp... Read more
You Be the Coder:
What If Vertebroplasty Crosses Regions?
Question: During a percutaneous vertebroplasty, the surgeon treats one thoracic level and ... Read more
Part 2:
4 More Ways to Ace Your Spinal Instrumentation Claims
Hint: -Multiple procedure- rules don't apply to same-session arthrodesis, bone grafts T... Read more
Call on Dedicated Codes for Instrument Removal/Reinsertion
Don't forget modifiers for global period surgeries If the surgeon removes instrumentati... Read more
'New' vs. 'Established' Isn't as Easy as You Think
Even if the patient has been to your office before, he might be new Proper coding for v... Read more
CPT 2008:
Popular Modifiers Face Changes
The AMA works harder to convince you of documentation's importance If you-ve been less ... Read more
Reader Questions:
2 Fusions at 1 Level = 1 Code Only
Question: If our surgeon performs a posterolateral fusion (22612) at the same level as a... Read more
Reader Questions:
Never Accept Add-on Reductions
Question: I have a discrepancy with a carrier regarding an ACDF. The reimbursement for t... Read more
Reader Questions:
Report 49215 for Sacral Excision of Tumor
Question: Our physician performed a sacral tumor excision, which required him to remove ... Read more
Reader Questions:
Count Levels, Not Nerves, for Block
Question: Our provider documented that he administered a nerve block to the left side of... Read more
Reader Questions:
Number of Rods Matters for Nonsegmental Instrumentation
Question: Our surgeon placed hardware at T3 and T4 and also at L3 and L4, with no fixati... Read more
You Be the Coder:
Is Fluoro Required for Facet Injections?
Question: One of our physicians performs facet injections without fluoroscopy in the off... Read more
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