Neurosurgery Coding Alert

CMS and CPT disagree about one key term. If you automatically assume you can't separately report a neurosurgeon's treatment of postoperative complications, you could be leaving money on the table. Knowing what qualifies as "typical" care will make your job easier. Myth #1: All Payers Treat Postop Claims the Same How you deal with postoperative complications depends on the payer you-re dealing with, experts say. Medicare carriers treat postoperative complications differently than insurers that follow CPT guidelines. Although both CMS and CPT guidelines indicate that the global surgical package includes "typical" postsurgical care, the two groups vary on their definition of typical -- and that means you need to think differently based on the payer.
According to Medicare, all postoperative E/M services, including for complications, are included unless they are completely unrelated or meet an exception. (See the article "These Services Are Not Part of the Global Surgical Package"- on page 4 for a list of exceptions.) For procedures, a complication must be significant enough to warrant a return to the operating room or you cannot report a separate procedure. The "Correct Coding" guidelines from CMS specifically state, "When the services described by CPT codes as complications of a primary procedure require a return to the operating room," you may report a separate procedure.
The difference: CPT guidelines are less strict and say that you may report some postoperative E/M services the neurosurgeon provides during the global period if they exceed typical follow-up care, even without a return to the OR. Myth #2: You Don't Need a Mod for Postop Services When you report postoperative services to payers that follow CPT guidelines, you-ll need to append modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the CPT code to indicate that the service took place during the surgery's global period.
Note: "Modifier 24 is indicated for use of an evaluation and management code during the postoperative period; therefore, only E/M codes should be used with this modifier," says Annette Grady, CPC, CPC-H, CPC-P, CCS-P, compliance auditor at The Coding Network, and executive officer on the AAPC's National Advisory Board.
To gain reimbursement from private payers for unrelated postoperative evaluations during the global period, you should append modifier 24 to the appropriate E/M service code, says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPC-OBGYN, CPC-CARDIO, manager of compliance education for the University of Washington Physicians (UWP) and Children's University Medical Group (CUMG) Compliance Program..
Example: If a patient returns to your office with a postoperative infection, such as a patient who has recently undergone parietal craniotomy for brain tumor excision (such as 61510, Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except menengioma) with advanced signs of [...]