Neurosurgery Coding Alert

CCI 15.2 went into effect July 1 and included more than 100 edit pairs that could affect your day-to-day neurosurgery coding, especially if you repeatedly report 76000.

Here's the scoop on changes you need to know.

The bulk of edits pair neuro-related procedures with 76000 (Fluoroscopy [separate procedure], up to 1 hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy) and classify the services as "Standard of medical/surgical practice." If your physician routinely uses fluoroscopy during injections, laminectomy, or stereotactic radiosurgery, double-check the edits before filing claims. The fluoroscopy bundles cover a wide range of procedures, such as:

• 62350 -- Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via external pump or implantable reservoir/infusion pump; without laminectomy

• 63045 -- Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [e.g., spinal or lateral recess stenosis], single vertebral segment; cervical

• 63170 -- Laminectomy with myelotomy (e.g., Bischof or DREZ type), cervical, thoracic, or thoracolumbar

• 63300 -- Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, cervical

• 63620 -- Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 spinal lesion.

"In general, the intraoperative imaging required for localization of spinal levels or for placement of instrumentation is considered a bundled service," explains Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison. "Therefore, fluoroscopy would not be separately reportable."

Stereotactic similarity: Codes that describe "stereotactic" procedures include the imaging used to perform the stereotactic procedure as an integral part of the service (typically CT or MRI scans), Przybylski adds. Because of this, the new CCI edits bundling fluoroscopy with these procedures simply reinforces how you should already be coding.

CPT 2009 introduced 13 new codes for therapeutic, prophylactic, and diagnostic injections and infusions. CCI 15.2 pairs one of those codes, +96376 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; each additional sequential intravenous push of the same substance/drug provided in a facility [List separately in addition to code for primary procedure]), with several neurology codes, including:

• 61796 -- Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 simple cranial lesion

• 61798 -- ... 1 complex cranial lesion

• 62267 -- Percutaneous aspiration within the nucleus pulposus, intervertebral disc, or paravertebral tissue for diagnostic purposes

• 64632 -- Destruction by neurolytic agent; plantar common digital nerve.

CCI 15.2 includes 3,565 new edit pairs and the majority have a modifier indicator of 0, meaning that you cannot use a modifier to bypass the edit policy. All but one of the edits for neurosurgery, however, have a modifier indicator of 1.

The pair of 62287 (Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method; single or multiple levels, lumbar [e.g., manual or automated percutaneous discectomy, percutaneous laser discectomy]) with 72295 (Discography, lumbar, radiological supervision and interpretation) has a 0 modifier indicator. Even if you have adequate documentation, you cannot submit your claim for 62287 and 72295 with modifier 59 (Distinct procedural service) and potentially get paid for both services, as discography is considered bundled into percutaneous disc decompression.

"There are 6,090 terminated edit pairs and unfortunately (from an administrative perspective), 5,002 of these have a termination date retroactive to last quarter," Frank Cohen, MPA, with MIT Solutions, Inc., said in a prepared statement about his CCI 15.2 analysis. "This means that if you were either denied payment or didn't bother to bill because the pair was scrubbed prior to claims submission (with a date of service of April 1 through June 30), you could likely resubmit and get paid if the pair would have been reported during this past quarter."

Learn more: For a complete look at CCI 15.2, visit http://www.cdc.gov/nchs/icd9.htm.