Neurosurgery Coding Alert

Of the more than 4,700 changes to the National Correct Coding Initiative (NCCI) this quarter (2,835 added edits and 1,908 deleted edits), several hundred will affect neurosurgical practice, primarily by bundling medicine services (90281-99600 series) with neurosurgical procedures (61000-64999 series). CMS and National Technical Information Services released NCCI, version 9.1, for the period April 1 to June 30, 2003.

The largest single category of edits in NCCI 9.1 to affect neurosurgeons bundles eight medicine codes to injection procedures in the 60000 series. The bundled codes include 90784, 90862, 93000, 93005, 93010, 93040, 93041 and 93042 which covers everything from injections and medication oversight to electrocardiograms and cardiovascular stress tests. The injection procedures to which NCCI bundles the medicine codes include single injection/catheter injections 62310-62319 and the entire nerve block series 64400-64530. In fact, however, these edits should have little effect on reimbursement, says Mitchell Carnes, office manager for Carnes and Associates, a surgical practice in Lake Park, Ill. "You wouldn't normally bill a separate injection or pharmacologic oversight with a nerve block, for instance," he says. "The edit just reinforces what coders should already know."

In a similar vein, version 9.1 includes the same injection procedures (62310-62319 and 64400-64530) as a standard component of physical medicine and rehabilitation procedures 97001-97004 (physical therapy evaluations); 97012-97039 (application of modalities such as traction, electrical stimulation, etc.); 97110-97535 (therapeutic procedures); and 98925-98929 (osteopathic manipulative treatment). Therefore, when providing any of these services, you may not charge additionally for the injections. These edits follow a general trend in NCCI in which injections of all types are increasingly included as inseparable from other procedures and services (although, as Carnes also notes, a neurosurgeon would rarely provide such physical therapy or rehabilitative services).

NCCI has classified category 3 code 0027T (Endoscopic lysis of epidural adhesions with direct visualization using mechanical means [e.g., spinal endoscopic catheter system] or solution injection [e.g., normal saline] including radiologic localization and epidurography), added to CPT in 2002, as mutually exclusive of 62263 (Percutaneous lysis of epidural adhesions using solution injection [e.g., hypertonic saline, enzyme] or mechanical means [e.g., catheter] including radiologic localization [includes contrast when administered], multiple adhesiolysis sessions; 2 or more days). Under NCCI guidelines, this means the two codes describe substantially similar procedures and therefore are not eligible for payment at the same time. The edit contains a "0" modifier indicator, thereby telling you that you may not override the edit by using a modifier.

And, 0027T now also bundles injection procedures 62281-62284 and 62310, as well as decompression of unspecified nerves (64722). In this case, the procedures are not considered exclusive of each other, but rather the more extensive procedure (0027T) is assumed to include the lesser procedure(s) (the injections or decompression) as part of the overall surgical package. Each of these edits contains a "1" modifier indicator, which means that you may override the edit if the procedures performed at the same time meet certain requirements. In this case, if the injection (62281-62284 or 62310) or decompression (64722) occurs at a different location from the lysis of adhesion (0027T), you may report both procedures and append modifier -59 (Distinct procedural service) to the lesser procedure (the injection).