Neurosurgery Coding Alert

Tip: Adhere to new arthroplasty bundles by following CPT guidelines.

Don't panic when you see the new year's voluminous Correct Coding Initiative (CCI) version 15.0. You can easily keep track of new arthrodesis, stereotactic cranial radiosurgery, and injection edits affecting your neurosurgery practice. All you need to do is follow CPT 2009's guidelines.

"Almost all the deleted CCI edits represent deleted CPT codes and not a change in policy," says Melanie Witt, RN, COBGC, MA, an ob-gyn coding expert based in Guadalupita, N.M.

Example: CPT 2009 deleted codes 0090T (Total disc arthroplasty [artificial disc], anterior approach, including discectomy to prepare interspace [other than for decompression] cervical; single interspace), 0093T (Removal of total disc arthroplasty, anterior approach cervical; single interspace), and 0096T (Revision of total disc arthroplasty, anterior approach cervical; single interspace).

Therefore, CCI 15.0 deletes bundles, such as the nonmutually exclusive edit that bundled 0090T with 22554 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; cervical below C2), +22845 (Anterior instrumentation; 2 to 3 vertebral segments ...), and +22851 (Application of intervertebral biomechanical device[s] [e.g., synthetic cage(s), threaded bone dowel(s), methylmethacrylate] to vertebral defect or interspace ...).

Additions: CPT 2009 replaced these deleted Category III codes with 22856 (Total disc arthroplasty [artificial disc], anterior approach, including discectomy with end plate preparation [includes osteophytectomy for nerve root or spinal cord decompression and microdissection], single interspace, cervical), 22861 (Revision including replacement of total disc arthroplasty [artificial disc], anterior approach, single interspace; cervical), and 22864 (Removal of total disc arthroplasty [artificial disc], anterior approach, single interspace; cervical). CCI 15.0 applies identical edits to new codes that follow CPT guidelines. For instance, you should not report 22856 with 22554, +22845, and +22851.

These edits, however, have a modifier indicator of "1," meaning you can bypass this edit with a modifier (such as 59, Distinct procedural service). Remember, these procedures must be distinct from one another (for instance, if they occur in separate anatomic locations).

CCI 15.0 bundles new stereotactic cranial radiosurgery codes 61796 (Stereotactic radiosurgery [particle beam, gamma ray, or linear accelerator] 1 simple cranial lesion) and 61798 (- 1 complex cranial lesion) into over 20 other neurosurgery codes, such as 61312-61315 (Craniectomy or craniotomy for evacuation of hematoma -). All of these edits carry a modifier indicator of "1."

This shouldn't be too much of a surprise. "Your physician won't usually perform radiosurgery with any of the craniotomy codes," says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison.

Remember: According to CPT guidelines, a "simple" cranial lesion is less than 3.5 cm in maximum dimension. Any lesion 3.5 cm in maximum dimension or larger is considered "complex." In addition, a lesion is classified as complex if it is adjacent (5 mm or less) to the optic nerve, optic chiasm, or optic tract or if the lesion is within the brainstem.

CPT 2009 brought renumbered infusion and injection codes (96360, 96365, 96372, 96374, and +96375), and CCI 15.0 responds by bundling these codes into all observation, hospital, emergency department, inpatient consultation, and critical care E/M services.

"These are not new edits per se, as the old codes representing these services were bundled in previous CCI versions," Witt says.-They carry an indicator of "1," which means the bundle can be bypassed with the appropriate modifier if the criteria for using than modifier are met (such as modifier 59).