Neurosurgery Coding Alert

New chemodenervation code includes injections.

CCI 17.0 establishes non-mutually exclusive edits for several common procedures performed with fluoroscopic guidance that you may encounter in your neurosurgery practice.

The guidance procedures being singled out include:

+77001 -- Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position) (List separately in addition to code for primary procedure)

77002 -- Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device).

According to CCI 17.0, you shouldn't report +77001 or 77002 when your physician administers trigger point injections (20552 or 20553) or administers tendon sheath injections (20550-20551).

CCI 17.0 also includes edits stating you shouldn't report +77001 with most diagnostic or therapeutic nerve injections (64400-64530) or most nerve destructions (64600-64681).Instead, just report the primary procedure itself.

Again, each edit pair carries a modifier indicator of "1." Watch your provider's documentation for times when you can justify reporting both services from the edit pair during the same encounter.

New Chemodenervation Code Overrides Other Injections

More than 100 non-mutually exclusive pairs include new code 64611 (Chemodenervation of parotid and submandibular salivary glands, bilateral). CCI 17.0 classifies 64611 as the comprehensive procedure when performed during encounters such as:

36000 -- Introduction of needle or intracatheter, vein

62310 -- Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic

64400-64450 -- Injection, anesthetic agent ...

95860-95870 -- Needle electromyography ...

95900-95904 -- Nerve conduction, amplitude and latency/velocity study, each nerve ...

95905 -- Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, each limb, includes F-wave study when performed, with interpretation and report. Indicator: The majority of edits involving 64611 carry a modifier indicator of "0," which means you cannot report the services with a modifier to try and be paid for both codes. If you submit both codes on the same claim, you'll receive an automatic denial for the Column 2 component code. Some edit pairs, however, carry a modifier indicator of "1." Check the CCI data carefully before submitting another code with 64611 to ensure you're within the guidelines.

FYI: CCI 17.0 includes 698,042 active edit pairs, according to an analysis by Frank Cohen, MPA, MBB, senior analyst for The Frank Cohen Group in Clearwater, Fla. Check the latest version at http://www.cms.gov/NationalCorrectCodInitEd/ to ensure you correctly report procedures.