Neurosurgery Coding Alert

Also: You continue to use same codes for phrenic nerve stimulation.

The Centers for Medicare & Medicaid Services (CMS) has introduced some new codes and revised a few which could potentially impact your neurosurgery practice. While the change in fluoroscopy code reinforces the correct use of the code, you need to pay particular attention to the addition of new moderate sedation codes — and fast. These changes go into effect January 1, 2017.

Mark the Change In Fluoroscopy Code

CPT^® 2017 includes a revised version of 77003 (new part of descriptor in bold): (Fluoroscopic guidance and localization of needle or catheter tip for spine or  paraspinous  diagnostic  or  therapeutic  injection  procedures  [epidural  or  subarachnoid] [List separately in addition to code for primary procedure]).

How does this impact your practice?  This change will probably not have much effect on your coding practices, as you always had to list 77003 separately in addition to the primary procedure code.

“Nonetheless, the number of spinal procedures for which fluoroscopy is considered inherent has continued to grow over the past several years,” says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison. “Updated descriptors and vignettes for many interventional procedures have resulted in the inclusion of fluoroscopy as inherent to performing the procedure. If a CPT^® code descriptor includes use of fluoroscopy, CPT^® 77003 would not be separately reportable.”

However, the revision is a welcome change as it now clarifies that code +77003 is an add-on code.

Find 3 New Codes for Moderate Sedation

Your physician may perform some neurological diagnostic or therapeutic procedures with moderate sedation. It is now the right time to gear up for changes in codes for reporting moderate sedation. The AMA has deleted some of the widely used moderate sedation codes. You will now have new options in 2017.

Overview of current codes: Moderate sedation codes 99143, 99144, and 99145 will be deleted effective Jan. 1, 2017. These existing codes are listed below:

• 99143 –  Moderate sedation services (other than those services described  by  codes  00100-01999)  provided  by  the  same  physician  or  other  qualified  health  care  professional  performing  the  diagnostic  or  therapeutic  service  that  the  sedation  supports,  requiring  the  presence  of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; younger than 5 years of age, first 30 minutes intra-service time
• 99144 – …  age  5  years  or  older,  first  30  minutes  intra-service  time
• +99145 – … each additional 15 minutes intra-service  time  (List  separately in addition to code for primary service).

Prepare for the change: In 2017, you will have 3 new codes which you can submit for moderate sedation provided by the same physician or other qualified health care professional. Your physician may use moderate sedation when performing some diagnostic or therapeutic services.

Following are the three new codes:

• 99151 – Moderate sedation services provided by the same physician or other  qualified  health  care  professional  performing  the  diagnostic  or  therapeutic  service  that  the  sedation  supports,  requiring  the  presence  of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient younger than 5 years of age
• 99152 – … initial 15 minutes of intraservice time, patient age 5 years or older
• 99153 – … each additional 15 minutes intraservice time (List separately in addition to code for primary service).

How are the new codes different? When you look at the existing and new codes, you will notice that the new code descriptors are the same as those for codes 99143-99145, with the key update being the addition of the phrase “other than those services described by codes 00100-01999.” “The intent is to distinguish anesthesia services from those provided by another health care professional, often the provider of the interventional service,” Przybylski says.

CMS Update: On Nov 2, 2016, the CMS issued a final rule that updates payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2017. According to this rule, “CMS is finalizing values for the new CPT^® moderate sedation codes and adopting a uniform methodology for valuation of the procedural codes that currently include moderate sedation as an inherent part of the procedure.”

You can read more about this update on: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-11-02.html.

CMS Continues Focus on Telehealth

In the last issue of the Neurosurgery Coding Alert Vol17n10, you read about the telehealth changes slated for 2017. Earlier this month, on Nov 2, 2016, the CMS released a final update on payment rates and policies. According to this rule, “CMS is also finalizing payment policies related to the use of a new place of service code specifically designed to report services furnished via telehealth.”

You can read more about this final rule at: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-11-02.html

Continue with Codes for Insertion, Replacement, Removal of Neurostimulators

The Category III codes for phrenic nerve stimulation were accepted at the May 2015 CPT^® Editorial Panel meeting for the 2017 CPT^® production cycle. However, due to the Category III code early release policy, these codes went in effect on January1, 2016, following the six-month implementation period which began on July 1, 2015. In 2017, you will continue to report the same phrenic nerve stimulation codes. “As with other Category III codes, such procedures are generally not widely disseminated, there is limited publication regarding efficacy, and/or the procedure uses technology that is not FDA-approved for the indication,” Przybylski says. “CPT^® provides a time-limited period for conversion to a Category I code if all of the conditions for Category I code designation are met.”

Table 1 lists the CPT^® codes you will have for neurostim­ulator systems that your physician may insert for central sleep apnea. Note that there are discrete codes for insertion or replacement and removal of the pulse generator and/or the sensing leads. In addition, you have codes for reposi­tioning and programing of the neurostimulator device.

Find out more: For more on the changes anticipated in 2017, you can check https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1654-P.html.