Neurosurgery Coding Alert

Watch for one detail in the latest Correct Coding Initiative (CCI) edits that will help you override a bundle when coding neurostimulator revision and replacement. Version 16.0 includes more than 649,000 active edits, according to Frank Cohen, MPA, of MIT Solutions Inc. in Clearwater, Fla. Read on for the most important highlights for your practice -- and the lowdown on how to adhere to additional edits without giving away procedures.

The bulk of neurosurgery-related edits apply to new codes 64490 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic; single level) and 64493 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral; single level). CCI 16.0 lists 64490 and 64493 as components of most musculoskeletal codes in the 22xxx family and virtually all nervous system and spinal codes (61000-64999).

You now have to remember that paravertebral facet joint injections are included with many common neurosurgery codes. Comprehensive procedures in the pairs range from 22010 (Incision and drainage, open, of deep abscess [subfascial], posterior spine; cervical, thoracic, or cervicothoracic) and 22532 (Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace [other than for decompression]; thoracic) to 61120 (Burr hole[s] for ventricular puncture [including injection of gas, contrast media, dye, or radioactive material]).

Exceptions: Mark your CPT book or other cheat sheets carefully, because a few cranial and spinal procedures aren't bundled with 64490 or 64493. For example, you can still code +61795 (Stereotactic computer-assisted volumetric [navigational] procedure, intracranial, extracranial, or spinal [List separately in addition to code for primary procedure]) with the injection codes when appropriate, although this would not be a typical coding pair.

Warning: CCI 16.0 assigns a modifier indicator of "0" to the edit pairs involving 64490 and 64493. That means you cannot use a modifier under any circumstances to bypass the edit and report both procedure codes for a single patient encounter.

When sifting through CCI 16.0, don't miss a few edits that apply when your neurosurgeon performs the procedure and also provides the moderate sedation.As Joanne Mehmert, CPC, CCS-P, president of Joanne Mehmert and Associates in Kansas City, Mo., points out, "There are two separate families of moderate sedation codes."

• For sedation provided by a physician other than the one performing the procedure, use 99148-99150 (Moderate sedation services [other than those services described by codes 00100-01999], provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports ...).

• When you report services for the physician who performs the procedure, bill the moderate sedation codes 99143-99145 (Moderate sedation services [other than those services described by codes 00100-01999] provided by the same physician 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 ...).

Vertebroplasty procedures 22520 (Percutaneous vertebroplasty, 1 vertebral body, unilateral or bilateral injection; thoracic) and 22521 (... lumbar) now include sedation codes representing when the surgeon provided the sedation (99143-+99145). So if your surgeon performs the vertebroplasty and provides the sedation, you cannot separately report the sedation.

Watch out: Thanks to CCI, you also won't be able to report sedation that another health care professional provides for a facet joint injection that your neurosurgeon performs. New paravertebral facet joint injection codes 64490-+64495 get paired with the remaining moderate sedation codes 99148-+99150.

Each of these edits pertaining to moderate sedation don't have an edit bypass option. They carry a modifier indicator of "0."

CCI brings you one gift. You can now separately different generator revision and removal.

For neurostimulator procedures 63685 (Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling) and 63688 (Revision or removal of implanted spinal neurostimulator pulse generator or receiver), the modifier indicator changes from "0" to "1." The change means you can report the procedures together under certain circumstances.

Action: Follow these quick guidelines to properly break the bundle:

• If your provider repositions the same generator, you cannot report both codes. CPT support this rule with the notation, "Do not report 63685 in conjunction with 63688 for the same pulse generator or receiver."

• If your physician removes one pulse generator and puts in another at a separate site, however, you can submit both codes (63685 and 63688) and append modifier 59 (Distinct procedural service) to 63688.

CCI 16.0 includes an extensive list of terminated code pairs that affect many neurosurgery codes. Don't let the list worry you, however.

"The deletions primarily involve codes that were either deleted from CPT 2010 or the consultation codes that are no longer covered by Medicare," says Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver.

The edits apply to deleted injection codes 64470 and 64475, plus consultation codes 99241-99245 (Office consultation for a new or established patient ...) and 99251-99255 (Inpatient consultation for a new or established patient ...).

As extensive as CCI 16.0 edits are, they apply only to payers that follow CCI.

"Many non-Medicare payers follow CCI edits when developing their bundling edits, but you can follow the AMA's guidance when billing non-Medicare payers," Mehmert says.

Example: The AMA currently does not bundle 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device) into 64510 (Injection, anesthetic agent; stellate ganglion [cervical sympathetic]). Therefore, you can bill 77002 with 64510 if your physician used fluoroscopic guidance and you're submitting to a non-Medicare payer that doesn't follow CCI edits.