Neurosurgery Coding Alert

Youll need a modifier on this code pair to bust bundle.

Be cautious about reporting a same-session spinal osteotomy with a laminectomy due to the new edits the Correct Coding Initiative (CCI) version 15.1 unloads.

First, Take a Large Picture View

Version 15.1, effective April 1, contains 304,038 additions. The file is one of the largest Ive seen, says Barbara Cobuzzi, MBA, CPC, CENTC, CPC-H, CPCP, CIMC, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J.

The official reason CMS has given for the size is a need to control anesthesia bundles.

Spot Where Most New Edits Pop Up

Despite the numerous edits, CCI aims its fire at a select few codes this round, with only 524 unique codes listed in column 2 of the new column 1/column 2 edit list, and only 48 codes make up the top 80 percent of those listed, said Frank Cohen, MPA, senior analyst with MIT Solutions, Inc. in Clearwater, Fla., in a March 12 news release.

The top most commonly-occurring codes in column 2 of the new non-mutually exclusive edits are 94250 (Expired gas collection, quantitative, single procedure [separate procedure]), 94680-94690 (Oxygen uptake, expired gas analysis), 95812-95819 (Electroencephalogram ...), and +96376 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential IV push [List separately in addition to code for primary procedure), all with 1.67 percent of the total (5,065 occurrences each), Cohen says.

Example: CCI bundles these codes into most of the procedures in the integumentary, musculoskeletal, and digestive sections of CPT. You can use a modifier to separate most of them if you can demonstrate that a separately identifiable, distinct procedure was performed.

In most cases, procedures such as injections performed during surgery would be included in the main surgical procedure anyway, so these edits shouldnt hurt too badly, says Heather Corcoran with CGH Billing in Lousiville, Ky.

Unlock Spinal Addition Bundles With This Tool

Neurosurgeons who perform spinal osteotomies and laminectomies need to take note of the following new edits.

Codes 22206 (Osteotomy of spine, posterior or posterolateral approach, three columns, one vertebral segment [e.g., pedicle/vertebral body subtraction];thoracic) and 22207 (& lumbar) are now components of the following laminectomy codes:

" 63251 -- Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; thoracic

" 63252 -- & thoracolumbar

" 63285 -- Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural;cervical

" 63286 -- &. thoracic

" 63287 -- & lumbar

" 63290 -- Laminectomy for biopsy/excision of intraspinal neoplasm; combined extradural-intradural lesion, any level.

Because the modifier indicator is 1, you can unbundle these edits with the appropriate modifier, such as 59 (Distinct procedural service). Make certain you have documentation to support it.

Cheer for These Deleted Pairs

CCI deletes 36 edit pairs, which may be a boon if the now-deleted edits were problematic for your practice.

For example: Youll no longer face an edit barring you from reporting 64470 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level) with 64412 (Injection, anesthetic agent; spinal accessory nerve).

In addition, CCI has deleted the edits bundling nervous system codes 62318-62319, 64415-64417, 64450, 64470, and 64475 into 64550 (Application of surface [transcutaneous] neurostimulator).

Want to know more? Download the complete list of CCI edits and the CCI Coding Policy Manual at www.cms.hhs.gov/NationalCorrectCodInitEd.