Neurosurgery Coding Alert

The Correct Coding Initiative (CCI) Version 16.1 went into effect April 1, with almost 40 percent of 112 new mutually exclusive pairs applying to neurosurgeons. Non-mutually exclusive edits include 67 pairs listing head, spine, or nervous system procedures as the comprehensive component.

As a whole, CCI 16.1 includes 2,054 new edit pairs, with 1,947 modifier indicator changes, says Frank Cohen, MBB, MPA, of MIT Solutions Inc. in Clearwater, Fla.

Mutually exclusive edits affecting neurosurgeons are split almost equally between arthrodesis and total disc arthroplasty procedures. Remember: Mutually exclusive edits mean the code pair "represents procedures or services that could not reasonably be performed at the same session by the same provider on the same beneficiary," according to CMS. Medicare will only reimburse you for the lesser-valued of the two procedures.

Codes for posterior and anterior arthrodesis for spinal deformity (22800-22812) and kyphectomy (22818-22819) are mutually exclusive with three disc arthroplasty procedures:

• 22861 -- Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical

• 22864-- Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical

• 22865 -- ... lumbar.

Edits also list 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace [other than for decompression], single interspace; lumbar) as mutually exclusive with Category III code 0195T (Arthrodesis, pre-sacral interbody technique, including instrumentation, imaging [when performed], and discectomy to prepare interspace, lumbar; single interspace]).

No impact: "One would never do an arthroplasty and fusion at the same level, so those edits should have no impact," says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison. The same applies to the edit involving 22630 and 0195T. "You can't do a 22630 at the same location as 0195T because it was already done with the pre-sacral fusion," Przybylski adds. "This edit should also have no impact."

The remaining mutually exclusive edits pertain to total disc arthroplasty procedures 22856-22865. Edits bundle each code with procedures ranging from 22600 (Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment) or 22554 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; cervical below C2) to 22800 (Arthrodesis,posterior, for spinal deformity, with or without cast; up to 6 vertebral segments).

Breakage applies: CCI assigns a modifier indicator of "1" to most of these edit pairs, meaning you can override the edit by reporting the appropriate modifier (such as modifier 59, Distinct procedural service). You might see this situation if the surgeon performs a single level arthroplasty at one level and an arthrodesis at a different anatomical level, Przybylski says.

Exception: The unbundling exception lies in pairings of 62360-62362 (Implantation or replacement of device for intrathecal or epidural drug infusion ...) with 62365 (Removal of subcutaneous reservoir or pump, previously implanted for intrathecal or epidural infusion). Those pairs carry a "0" modifier indicator, so you cannot report the procedures together under any circumstances. Previous edits for 62365 with 62360-62362 allowed you to report both procedures because of the "1" modifier indicator. CCI 16.1 deletes the edits with the "1" modifier in favor of the new edits with a "0."

Previous editions of CCI categorized fluoroscopic guidance as a component of common spine or nervous system procedures, and the non-mutually exclusive (NME) edits of CCI 16.1 are no exception. Remember: Nonmutually exclusive edits pair codes for two services that physicians often perform during the same session. CCI lists one code as the comprehensive procedure -- meaning it's considered the larger procedure -- and the second code as the component, which is a piece of the comprehensive.

Nervous system news: Guidance code 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) is a component of procedures such as 62267 (Percutaneous aspiration within the nucleus pulposus, intervertebral disc, or paravertebral tissue for diagnostic purposes) and 63610 (Stereotactic stimulation of spinal cord, percutaneous, separate procedure not followed by other surgery). Similar pairings mark 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, or sacroiliac joint], including neurolytic agent destruction) as a component of the same procedures.

Spine watch: Several spine-related edits involve 22864 (Removal of total disc arthroplasty [artificial, disc], anterior approach, single interspace; cervical). CCI 16.1 classifies 22864 as the comprehensive procedure that overrides components such as 22505 (Manipulation of spine requiring anesthesia, any region) and 62291 (Injection procedure for discography, each level; cervical or thoracic).

All non-mutually exclusive edits for neurosurgery carry a "1" indicator, so you might be able to report both procedures of a pair in certain circumstances, typically when the procedures are performed at different anatomical levels.