Neurosurgery Coding Alert

Hint: Pay special attention to modifier indicator changing from “1” to “0.”

CMS recently released its quarterly Procedure-to-Procedure (PTP) Correct Coding Initiative (CCI) updates for 2018. CCI 24.2 became effective on July 1, 2018.

Read on to see how CCI 24.2 will impact your neurosurgery practice’s bottom line.

Catch This 22630/22610 PTP Pair Addition

Addition: If, in the past you reported 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar) in conjunction with 22610 (Arthrodesis, posterior or posterolateral technique, single level; thoracic (with lateral transverse technique, when performed)), you should know that there is now a PTP edit for these two codes.

So, now, if you report both codes of this PTP pair for the same patient on the same date the service, the Column 1 code, 22630, is eligible for payment, but your payer will deny the Column 2 code — 22610.

Because you can only report a single primary posterior fusion code (which in this example is 22630), you cannot report another primary posterior fusion code (eg. 22610), explains Gregory Przybylski, MD, past chairman of neurosurgery and neurology at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey.

If a thoracolumbar fusion was performed, you would report the levels of posterior fusion performed beyond the level of posterior lumbar interbody fusion with +22614 (Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure)), regardless of whether these are lumbar or thoracic levels, Przybylski adds.

Modifier indicator: The modifier indicator for this PTP pair is “1, which lets you know that an edit can be overcome, if appropriate, with the use of a modifier, such as modifier 59 (Distinct procedural service). However, just because you can add a modifier, this doesn’t mean you should. Be sure you have the supporting documentation for requesting payment for both codes before adding a modifier to the bundled pair.

“Modifier 59 and other CCI-associated modifiers should not be used to bypass a CCI edit unless the proper criteria for use of the modifier 59 are met,” says Mary I. Falbo, MBA, CPC, president and CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania, adds. “Documentation in the medical record must satisfy the criteria required by any CCI-associated modifier that is used.”

Example: You can use modifier 59 when the surgeon performs the bundled procedures for different anatomic sites/regions, different organs, or in limited situations on different, non-contiguous lesions in different anatomic regions of the same organ, Falbo explains.

Caution: You should never append modifier 59 to an evaluation and management (E/M) service.

Mind This Modifier Indicator Change

This quarter, many of the neurosurgery-related changes to the CCI edits can be found when you look at the modifier indicators changing from “1” to “0”. This is especially important to note because when you used to be able to break an edit with these pairs, now you cannot because the indicator has changed to “0.”

Example: Code 22633 (Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar) is a Column 1 code for both 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed)) and 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar). Since there are now new 22633/22612 and 22633/22630 PTP edits, you will only get paid for the 22633 service, if you report these codes in conjunction with each other.

Discover Myriad of 38222 PTP Pair Modifier Indicator Updates

If you report 38222 (Diagnostic bone marrow; biopsy(ies) and aspiration(s)), know that the modifier indicator for a slew of PTP edits containing this code as the Column 2 code have changed from “1” to “0.” The Column 1 codes in these PTP edit pairs include the following codes from the musculoskeletal system section of CPT^®:

• »Vertebral body biopsy codes 20250 and 20251
• Spine surgery autograft add-on codes +20937 and +20938
• Partial excision of posterior vertebral component codes 22100-+22103
• Partial excision of vertebral body codes 22110-+22116
• Osteotomy codes 22206-+22226
• Fracture and dislocation codes 22310-+22328
• Arthrodesis codes 22532-22812
• Kyphectomy codes 22818 and 22819
• Spinal fusion exploration code 22830
• Spinal instrumentation codes +22840-+22870.

You should also be on the lookout for modifier indicator changes in PTP pairs, with 38222 as the Column 2 code, from the nervous system section of CPT^®. The Column 1 codes in these pairs are as follows:

• Spinal cord endoscopic decompression code 62380
• Laminectomy codes 63001-63017; and 63045-+63048
• Laminotomy codes +63020-+63044
• Laminoplasty codes 63050 and 63051
• Transpedicular and costovertebral approaches for posterolateral extradural exploration and decompression codes 63055-+63066
• Anterior and anterolateral approaches for extradural exploration and decompression codes 63075-+63091
• Lateral extracavitary approaches for extradural exploration and decompression codes 63101-+63103
• Incision codes 63170-63200
• Laminectomy excision of lesions, other than herniated disc codes 63250-+63295
• Excision, anterior, or anterolateral approach for intraspinal lesion codes 63300-+63308

Don’t miss: It is important to remember that bone marrow aspirate for spinal fusion procedures is no longer reportable with 38220 (Diagnostic bone marrow; aspiration(s)), which is applicable to diagnostic bone marrow biopsy, Przybylski says. For bone marrow aspiration to harvest material for spinal fusion beginning in 2018, the appropriate code to report is +20939 (Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision (List separately in addition to code for primary procedure)).