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Neurosurgery Coding Alert

Co-surgery Strategies:
62 Puts Your Co-surgeon Claims on Payment Fast Track
Tip: Append both op notes when you submit to payers.Watch your neurosurgeon's op note for ... Read more
Nerve Studies:
95900 to 95904: Know Which Nerve Conduction Study Code Is Right for You
Use this 3-step guide to chart your path to accurate coding.Choosing the appropriate code ... Read more
E/M Pointers:
2 FAQs Guide You to Better Discharge Day, Phone Call Coding
No need to fret over applying proper codes with this guidance.Take a quick refresher on tw... Read more
News You Can Use:
Congress Passes 1-Year Medicare Pay Fix
New legislation ensures that you'll avoid the scheduled 25 percent drop in Medicare pay ne... Read more
Reader Questions:
64999 Describes Return Instrumentation Service
Question: One of our patients had an ALIF of L5-S1. Nine months later, he came back with c... Read more
Reader Questions:
64708 and 64727 Get Multiple Use
Question: Can we bill 64708 (Neuroplasty, major peripheral nerve, arm or leg; other than s... Read more
Reader Questions:
Dissect Fracture Care Complexities
Question: Can you help with this scenario? One of our neurosurgeons performed drainage and... Read more
Reader Questions:
61795 Goes Away, New Stereotactic Codes Debut
Question: I understand that code 61795 is being replaced by 61781, 61782, and 61783 in CPT... Read more
Reader Questions:
61322 or 61323? Choose One to Describe Herniation Service
Question: This may be very simple, but I can't think of the correct procedure for a cranie... Read more
Reader Questions:
63042 Fits Re-Exploration Work
Question: How should I code re-exploration of L3/4, L4/5 with revision of L3 through L5 ha... Read more
You Be the Coder:
22558 May Need Mod 22 for Separate Decompression
Question: When one of our neurosurgeons performs an anterior lumbar fusion and a radical d... Read more
CPT 2011:
64479-64484, Debridement Changes Refine Your Pain and Wound Care Reporting
Extra: Here's how the observation services expansion can eliminate payer coding variations... Read more
ICD-9 Update:
Update Your CVA Dx Coding With These Guidelines
Watch terms and deficits to choose legitimate codes.Neurosurgery coders who overlooked the... Read more
Inpatient Billing:
Capture Split/Shared Visit Payments By Following 3 Simple Rules
Tip: Don't let Medicare's 2010 consultation changes alter your split visit billing.When yo... Read more
Reader Questions:
Watch 22214 With Decompression Services
Question: I have two similar cases that I need help coding:1st case: L4-5 decompression, b... Read more
Reader Questions:
96372 With 62310 or 62311? Know the Service First
Question: A patient visited our office for therapeutic injections of Toradol and Kenalog. ... Read more
Reader Questions:
99291, 99292: Calculate Correctly
Question: The patient's chart includes the following statement: "Critical care time spent ... Read more
Reader Questions:
Apply Surgical Fees to New Arthodesis Codes
Question: I need to prepare a surgical estimate for a 2-level anterior cervical discectomy... Read more
Reader Questions:
Revise Depressed Skull Fracture Reporting
Question: My surgeon said he did an emergency craniotomy for depressed skull fracture, but... Read more
Reader Questions:
Bill Consultations With a Referral
Question: When another doctor refers a patient to our surgeon, who meets with the patient ... Read more
You Be the Coder:
Check Open Reduction With Spondylothesis
Question: Would a diagnosis of acquired spondylolisthesis (738.4, Acquired spondoylolisthe... Read more
CPT 2011:
61781, 61782, 61783 Enhance Your Stereotactic Procedure Accuracy
2 new arthrodesis codes, revisions to 20930, 20931 coming your way for Jan. 1Additional st... Read more
Note These Spinal Injection, Neuroplasty Code Changes
Keep this list handy as reference for changes to descriptors for epidurals and neuroplasty... Read more
CCI 16.3:
0228T, 0230T Key Players in CCI 16.3 Edits
Report the other pain management procedure -- sometimes.The latest version of Correct... Read more
Reader Questions:
62368 Reprogramming Makes E/M Necessary
Question: When we have a patient come into the office for reprogramming of a pump implant ... Read more
Reader Questions:
64680 Covers Splanchnic Block
Question: Our pain management specialist administered a neurolytic celiac plexus block and... Read more
Reader Questions:
Hematoma Evacuation Requires Extra Work
Question: Can you help me report the following procedure? Procedure: 1. Occipital and subo... Read more
Reader Questions:
Avoid a 'Finders Keepers' Overpayment Mentality
Question: We've discovered that a patient overpaid us on her copay. We collected $50, whic... Read more
Reader Questions:
Watch the Clock for Brain Mapping Services
Question: If a physician performs a two-hour and 30-minute functional cortical and subcort... Read more
You Be the Coder:
63047 and 63048 Co-Surgery Services
Question: Our neurosurgeon performed a L2-3, L3-4 revision laminectomy (63047 and 63048) a... Read more
Spine Surgery Strategies:
63047, 63015, 63251: Use 3 Case Studies to Guide Your Multilevel Spinal Surgery Reporting
Bust denials with this advice on the unique coding requirements of laminotomy, laminectomy... Read more
Modifier Refresher:
Achieve Modifier 25 Success With These Easy Steps
Understand 'significant' and 'separate' to move in the right direction.Knowing when to rep... Read more
Billing:
Know Your State's Prompt Pay Laws -- And Appeal When Necessary
Medicare requires contractors to pay your clean claims within 30 days, but private payers ... Read more
Reader Questions:
Note Site for Cerebrospinal Fluid Drain
Question: Can you help me with the following procedure? "T12, 11, 12 dissection to spinous... Read more
Reader Questions:
Look for Decompression in Interspace Cage Procedure
Question: I am telling a provider that we can't bill a corpectomy (63090) to prepare the i... Read more
Reader Questions:
Consider Reason for Office Consult Post-Decompression
Question: One of our patients had surgery for a decompression. The patient returned to the... Read more
Reader Questions:
Confirm Instrument for Ventricular Cyst Fenestration
Question: The surgeon's operative report states "ventriculoscope to fenestrate the 3rd ven... Read more
Reader Questions:
Review Process for Interspinous Distraction Device Insertion
Question: Please advise me on how to report the following procedure: Preoperative diagnosi... Read more
Reader Questions:
Bill Single Injection For Intercostal Nerve Blocks
Question: Should I use 64421 when my surgeon performs a single injection for a thoracic in... Read more
You Be the Coder:
Go Unlisted With Bone Fiducials
Question: My physicians have started doing bone fiducials before deep brain stimulator imp... Read more
CCI 16.2:
Double Check Before Separately Reporting Paravertebral Facet Injections
Edits bundle J0670 with 64405, 64450, and 64493.Nerve block and neurolytic agent injection... Read more
CCI 16.2:
Change Columns For +95920 and Others
Edits switch columns for polysomnography, needle EMG pairs.If your practice reports polyso... Read more
CPT 64622-64627:
Prevent Denials By Applying UHC's Latest Thermal RFA Policy
This payer wants to see you report 77003 separately.If your practice participates with Uni... Read more
E/M Coding:
Don't Bill High-Level E/M Codes Until You Read This
Sicker patients may not always mean higher MDM.If your neurosurgeon bills a lot of high-le... Read more
Reader Questions:
Reinsertion Status Guides Screw Removal Code
Question: What CPT code should we use for removal of broken iliac screws? Maine Subscriber... Read more
Reader Questions:
No Inpatient Contact = No E/M Service
Question:I read "When reporting discharge day management service, you must provide and doc... Read more
Reader Questions:
Report 61343 and 61524 Together
Question:Our surgeon routinely performs 61343 to repair Chiari malformation. Now we have a... Read more
Reader Questions:
Resolve Secondary Payer Issues With Conversations
Question:Our doctor performed surgery on a patient 11 months ago. We just learned that the... Read more
Reader Questions:
Intractable Seizure Dx Disappears After Surgery
Question:Our practice recently saw a patient who had been having intractable seizures. The... Read more
Reader Questions:
Reinsertion Status Guides Screw Removal Code
Question:What CPT code should we use for removal of broken iliac screws?Maine SubscriberAn... Read more
You Be the Coder:
Link Hematoma to Discectomy Fusion
Question:What diagnosis can I use for "status post anterior cervical discectomy fusion wit... Read more
Kyphoplasty vs. Vertebroplasty Don't Miss Out on Ancillary Procedures With Kyphoplasty, Vertebroplasty
Report radiologic supervision and interpretation, but skip bone biopsies.When your neurosu... Read more
ICD-9 2010 Update:
Improve Your Seizure and Cognitive Testing Coding With New ICD-9 Codes
But you should keep using 724.3 for spinal stenosis.You're likely holding your breath in a... Read more
Evaluation and Management:
Scope Out Potential Level 4 and 5 E/Ms By Knowing Crucial HPI Facts
Watch out for CPT/Medicare differences when counting HPI elements.If you're not accurately... Read more
News You Can Use:
Welcome a 2.2 Percent Medicare Pay Boost For the Rest of This Year -- Finally
But the news isn't all good -- first, you faced a week of lower payments, and second,... Read more
Reader Questions:
Turn to 97605, 97606 for Postop Wound Vac
Question: Our provider completed a postoperative wound-vac change in the office. Can we bi... Read more
Reader Questions:
Reporting 97140 Multiple Times Is Possible
Question: The physician saw a patient for cervical and lumbar problems and provided manual... Read more
Reader Questions:
Follow Signature Rules or Risk Payments
Question: One of our physicians likes to sign everything with just his initials, or someti... Read more
Reader Questions:
Verify Exact Procedure for Thoracic Laminotomy
Question: The neurosurgeon completed bilateral laminotomy to T8-9 and T9-10 in the prone p... Read more
Reader Questions:
Shunt Tap Billing During Global Is OK
Question: Can we bill a shunt tap for an inpatient within the global period for the shunt ... Read more
Reader Questions:
Look at Depth for Piriformis Muscle Mass Excision
Question: I have an operative note for "removal of painful mass (lipoma) left sciatic notc... Read more
You Be the Coder:
Verify 20693 or 20999 for Halo Vest Adjustment
Question: The neurosurgeon adjusted a misaligned halo vest under anesthesia. He later remo... Read more
Kyphoplasty vs. Vertebroplasty:
4 Tips Help You Easily Capture Percutaneous Kyphoplasty, Vertebroplasty Payment
Don't let missing cervical procedure codes thwart your claims.If you don't know the differ... Read more
Modifier Roundup:
Tackle Follow-Up Procedure Coding With Clear Cut 58, 78, and 79 Rules
Don't miss out on extra pay when global period resets.Just because you routinely append mo... Read more
News You Can Use:
Avoid 99221 Denials By Understanding How Former Consult Levels Measures Up
Absent consult codes, CMS offers this solution for low-level initial care.What should you ... Read more
Reader Questions:
Submit All Claims to a Contracted Payer
Question: We have a patient who wants us to give her the allowable amounts for a procedure... Read more
Reader Questions:
Capture Long E/M With +99354
Question: My physician spent 105 minutes with a new patient in the office. Is 99205 the on... Read more
Reader Questions:
Rule Out Billing Without Face-to-Face Encounter
Question: From his office a physician reviews lab test results and, by telephone, orders a... Read more
Reader Questions:
Collect Surgical Deductibles Up Front
Question: We often have patients who don't pay their deductible after surgery. Is there a ... Read more
You Be the Coder:
Multiple Procedures Across Multiple Spinal Levels
Question: During an operative session, my neurosurgeon performed the following procedures:... Read more
Surgical Coding Corner:
Narrow Your Instrumentation Coding Choices With These Location Tips
Get the lowdown on these add-ons the surgeon might use to aid arthrodesis.Coders can trip ... Read more
E/M Best Practices:
Bone Up on New-Established Rules to Eradicate E/M Miscodes
Here's why the new-established question matters more than ever for your surgeon.Let's say ... Read more
E/M Best Practices:
Master New Patient E/Ms or Leave Cash on the Table
Financial fallout considerable if you eschew new patient codes too often.For neurosurgery ... Read more
News you can use:
Feds Down Conversion Factor, Up DEXA Scan RVUs
Midyear switch means about 1 RVU more for bone density study.According to a recent CMS com... Read more
Reader Question:
Look at Destruction Level for Thermocoagulation Code
Question: How do we code thermocoagulation of the greater occipital nerve?New York Subscri... Read more
Reader Question:
Check With Payer for Correct 50 Placement
Question: CPT instructs to include modifier 50 to indicate bilateral completion of 63030. ... Read more
Reader Question:
Avoid 10121 for Ommaya Reservoir Removal
Question: We followed AANS advice and billed an 'unlisted' code for Ommaya reservoir remov... Read more
Reader Question:
Start With 63045, Then Code Foraminotomy
Question: Our neurosurgeon completed posterior cervical laminectomy (C4, C5, and C6), part... Read more
Reader Question:
Note Follow-Ups As Part of Global - Usually
Question: A patient developed an infection several days after surgery and came to the offi... Read more
Reader Question:
Include Decompression in Gill Procedure
Question: The surgeon performed a Gill procedure at L5-S1 and performed a wide foraminotom... Read more
Reader Question:
Add Modifier 24 for New Service During Global
Question: The neurosurgeon completed L5 laminectomy on a patient. Two weeks later, the pat... Read more
You Be the Coder:
Code PEEK and Instrumentation Separately
Question: Our neurosurgeon placed PEEK interbody spacers after discectomy and filled the i... Read more
CCI 16.1 Targets Arthrodesis, Arthroplasty With Both Mutually and NME Neurosurgery Edits
Pay attention to the edits that carry modifier indicator "0." The Correct Coding Initiati... Read more
4 Steps Simplify Cranial Sterotactic Radiosurgery Coding
Descriptor details and correct counting keep you away from traps. You know how coding gui... Read more
Terminology Check:
Draw the Line Between Radiosurgery Tactics
Neurosurgeons use a variety of modalities to perform stereotactic radiosurgery, depending ... Read more
Clarify Anatomic Details When Counting and Coding Interspaces
Learning your surgeon's punctuation preferences offers valuable clues. Navigating the ana... Read more
Reader Questions:
Check Choices for Multiple Hemilaminectomies
Question: Our surgeon performed left C7-T1 hemilaminectomies,extradural opening for debul... Read more
Reader Questions:
Count +22851 by Interspace
Question: I've always been of the understanding that you should bill +22851 per interspac... Read more
Reader Questions:
61760 Includes Stereotactic Electrode Removal
Question: The surgeon placed stereotactic depth electrodes for long-term seizure monitori... Read more
Reader Questions:
Reporting 63012 Infers Spondylolisthesis
Question: A few of our physicians document "instability" or "instability with caudal root... Read more
Reader Questions:
Reason Dictates Separate Facetectomy Code
Question: Our neurosurgeon performed a facetectomy at C7 and T1 to allow for arthrodesis.... Read more
Reader Questions:
Medication Wash is Part of Procedure Code
Question: When our neurosurgeon performs a lumbar disc excision he always pours over the ... Read more
Reader Questions:
Submit 63663 for Each Revised Electrode Array
Question: The physician replaced two sets of spinal cord stimulator leads with eight... Read more
Reader Questions:
Define These 'Mutually Exclusive' and 'Bundled' Terms
Question: Would you explain what the differences are between mutually exclusive and "colu... Read more
You Be the Coder:
Resection Hinges on Tumor Location
Question: Our neurosurgeon and an otolaryngologist performed co-surgery for a case descri... Read more
Don't Get Discouraged by Decompressive Discectomy Traps
Hint: Focus on approach and potential add-ons to file clean claims. When your neurosurgeo... Read more
Clip & Save:
Boost Spinal Fusion Reimbursement With Cages and Grafts
Stop additional code opportunities from slipping by. When your surgeon performs spinal fu... Read more
2 Tips Lead to Modifier 22 Success Every Time
Watch frequency and provide documentation to rationalize extra pay. Applying modifier 22 ... Read more
Does Your Case Qualify for Modifier 22?
Check your op report against these examples. Coding for complicated surgeries doesn't aut... Read more
READER QUESTIONS:
Check 744.05 for Tegmen Defect Diagnosis
Question: What is the correct diagnosis to report for a tegmen defect? Illinois Subscribe... Read more
READER QUESTIONS:
+22851 First Bet for Spinal Spacers
Question: When our surgeons complete anterior cervical fusion (ACF) they insert a titaniu... Read more
READER QUESTIONS:
Count Vertebrae for Instrumentation
Question: Our surgeon performed anterior cervical discectomy at C3-C4, C4-C5, and C5-C6. ... Read more
READER QUESTIONS:
Say No to 76003 With Paravertebral Injection
Question: CPT 2010 states that fluoroscopy is included with paravertebral facet joint inj... Read more
READER QUESTIONS:
Choose Best E/M for Ventric Follow-Up
Question: Our neurosurgeon clipped an intracranial aneurysm and created a separate ventri... Read more
READER QUESTIONS:
New Flap, No Revision = Tissue Transfer
Question: The skin over a patient's VP shunt stretched quite thin, so the surgeon opened ... Read more
READER QUESTIONS:
No-Go for Reporting 63030 With 63047
Question: Our physician completed a laminectomy on L5 and a hemilamin-ectomy on L4, but t... Read more
READER QUESTIONS:
Look to 61520 for Brain Tumor Excision
Question: The surgeon made a postauricular incision and dissection down to the turn from ... Read more
READER QUESTIONS:
Shunt Check Qualifies for 62230
Question: The neurosurgeon plans to check a patient's cerebrospinal fluid shunt  to ... Read more
You Be the Coder :
Catch All Codes for Neuroendoscopy and Graft
Question: The surgeon performed a transnasal endoscopic approach and resection of a pitui... Read more
Answer These 3 Questions for Spinal Graft Coding Success
Tip: Don't expect separate reimbursement for all spinal grafting codes. If spinal bone gr... Read more
Demystify Decompression Coding by Checking Evacuations
Complications and surgical approach can drive your options. Coding for decompression and ... Read more
Master Modifier GX to Prepare for April 1 ABN Change
Coming soon: Modifier GA will apply to required ABNs only. If you started coding many yea... Read more
Reader questions:
Complex or Simple Guides Lesion Coding
Question: My neurosurgeon completed stereotactic radiosurgery for an acoustic neuroma, in... Read more
Reader questions:
Steer Clear of Double-Billed Radiology Procedures
Question: A patient suffered a blow to the head and displayed symptoms of dizziness, slee... Read more
Reader questions:
Yes to Exploration With Spinal Fusion -- Maybe
Question: Our neurosurgeon explored spinal fusion at he same level he performed sing... Read more
Reader questions:
Shunt Tap Billing During Global Is OK
Question: Can we bill a shunt tap for an inpatient within the global period for the shunt... Read more
Reader questions:
Look at Depth for Piriformis Muscle Mass Excision
Question: I have an operative note for "removal of painful mass (lipoma) left sciatic not... Read more
Reader questions:
Verify Exact Procedure for Thoracic Laminotomy
Question: The neurosurgeon completed bilateral laminotomy to T8-9 and T9-10 in the prone ... Read more
Reader questions:
Shunt Revision Likely Falls Under 62225
Question: The surgeon identified the patient's previous shunt and disconnected the valve ... Read more
Reader questions:
Choose Multiple Codes for Craniotomy, Encephalocele Repair
Question: The surgeon performed a bone flap craniotomy (left middle cranial fossa, extrad... Read more
You be the coder:
Verify Burr or Twist Drill Hole for Ventriculostomy
Question: An operative report states, "ventricular catheter placed in the lateral ventric... Read more
5 do's and don'ts steer you through CCI 16.0's sedation, neurostimulator edits
Say goodbye to paravertebral facet injections with I&D, arthrodesis, burr hole -... Read more
Distinguish 4 Spinal Procedures With This Detail
The P and A in PLIF, ALIF, TLIF, and XLIF signal your base code. When your neurosurgeon i... Read more
Count Separate Nerves for Neuromuscular Junction Tests
Your denials can be cut, thanks to this easy tip. Just because your neurosurgeon's docume... Read more
Reader questions:
Discectomy, laminectomy could go together
Question: Is the laminectomy included in the T12 burst fracture code? North Dakota Subscr... Read more
Reader questions:
Cervical collar fitting is part of repair code
Question: Can we code for fitting of a cervical collar following closed treatment, or is ... Read more
Reader questions:
Neurogenic claudication similar to stenosis
Question: What diagnosis should we assign to neurogenic claudication? Iowa Subscriber Ans... Read more
Reader questions:
Yes, you can report 61343 and 61524 together
Question: Our surgeon routinely performs 61343 to repair Chiari malformation. Now we have... Read more
Reader questions:
Benign of unspecified dictates mass diagnosis
Question: What's the best diagnosis code for a spinal meninges mass? Wyoming Subscriber A... Read more
Reader questions:
Check out CPT's new symbol for 2010
Question: I noticed some of the codes in CPT 2010 have a # mark beside them. What does th... Read more
Reader questions:
Documentation could support aneurysm access and clip
Question: Our surgeon performed a skull-based procedure to access an aneurysm, then perfo... Read more
You Be the Coder:
X-Close Code Depends On Other Procedures
Question: How should we code for annulus repair (X-close) with a discectomy? Can we bill ... Read more
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