Neurosurgery Coding Alert

In the recently released Correct Coding Initiative (CCI) 7.0, several major changes were made that will improve neurosurgical collections and impact coding.

Cherie L. McNett, a representative from the Washington office of the American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS), reports that these edits should have been made in CCI Edits version 6.2, which was implemented by some carriers on July 1st and others on Sept. 5th, 2000. Accordingly, several incorrect coding pairs involving 61795 were distributed to carriers, resulting in denials or reductions.

The AANS/CNS goes on to recommend that after the Jan. 1, 2001, implementation of CCI version 7.0, all denied claims using 61795 with an appropriate procedure code should be resubmitted for retroactive repayment. If your practice has denials prior to Sept. 5, make sure that your documentation indicates they were made before that time. McNett also suggests referencing the recommendation by the AANS/CNS in your cover letter.

The following are the changes that were made:

A. 61795 (stereotactic computer assisted volumetric [navigational] procedure, intracranial, extracranial, or spinal [list separately in addition to code for primary procedure]) has become a component of the following comprehensive codes:

61720 creation of lesion by stereotactic method, including burr hole(s) and localizing and recording techniques, single or multiple stages; globus pallidus or thalamus;

61735 subcortical structure(s) other than globus pallidus or thalamus;

61750 stereotactic biopsy, aspiration, or excision, including burr hole(s), for intracranial lesion;

61751 with computerized axial tomography and/or magnetic resonance guidance;

61760 stereotactic implantation of depth electrodes into the cerebrum for long term seizure monitoring);

61770 stereotactic localization, including burr hole(s), with insertion of catheter(s) or probe(s) for placement of radiation source;

61790 creation of lesion by stereotactic method, percutaneous, by neurolytic agent [e.g., alcohol, thermal, electrical, radiofrequency]; gasserian ganglion;

61791 trigeminal medullary tract;

61793 stereotactic radiosurgery [particle beam, gamma ray or linear accelerator], one or more sessions;

63600 creation of lesion of spinal cord by stereotactic method, percutaneous, any modality [including stimulation and/or recording];

63610 stereotactic stimulation of spinal cord, percutaneous, separate procedure not followed by other surgery;

63615 stereotactic biopsy, aspiration, or excision of lesion, spinal cord;

76095 stereotactic localization guidance for breast biopsy or needle placement [e.g., for wire localization or for injection], each lesion, radiological supervision and interpretation; and

77432 stereotactic radiation treatment management of cerebral lesion(s) (complete course of treatment consisting of one session)

B. 64553 and 64573 with 61885 effective Jan. 1, 2001, the edits denying usage of 64553 and 64573 (incision and percutaneous implantation of neurostimulator electrodes; cranial nerve) with component code 61885 (incision and subcutaneous placement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array) have been eliminated. The ANNS/ CNS also recommends that as of now, any previously denied claims with these code pairs should be resubmitted to local Medicare carriers for retroactive payment.

However, HCFA has not yet eliminated the edit bundling comprehensive codes 64553 and 64573 with component code 61886 (two or more arrays). In addition, 61885 now includes 95974 (electronic analysis of implanted neurostimulator pulse generator system [e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements]; complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour). In the introductory language to neurostimulator codes 61850-61888, this CCI pairing is in direct contravention to CPT 2001, which states, For initial or subsequent electronic analysis and programming of neurostimulator pulse generators, see codes 95970-95975.