Neurosurgery Coding Alert

Watch for bundling and guard your payment.

The new CCI edit 18.3 bundles the wound repair codes with those for subdural tap and ventricular puncture. Make a note of the codes below to ensure you never report the repair codes without a modifier when reporting them with the codes for subdural tap and ventricular puncture.

• 61000 -- Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; initial
• 61001 -- Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; subsequent taps
• 61020 -- Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; without injection
• 61026 -- Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; with injection of medication or other substance for diagnosis or treatment
• 61050 -- Cisternal or lateral cervical (C1-C2) puncture; without injection (separate procedure)
• 61055 -- Cisternal or lateral cervical (C1-C2) puncture; with injection of medication or other substance for diagnosis or treatment (e.g., C1-C2)
• 61070 -- Puncture of shunt tubing or reservoir for aspiration or injection procedure

Append Correct Modifiers

The following codes are column 2 codes for the ventricular puncture and subdural tap codes listed above, but modifier 59 (Distinct procedural service...) is allowed in order to differentiate between the services provided. Do not forget to use appropriate modifiers with the following codes:

• 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less) -- 12021 (Treatment of superficial wound dehiscence; with packing)
• 12031 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.5 cm or less) -- 12057 (Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm)
• 13100 (Repair, complex, trunk; 1.1 cm to 2.5 cm) -- 13153 (Repair, complex, eyelids, nose, ears and/or lips; each additional 5 cm or less [List separately in addition to code for primary procedure])

"It would be very unusual to use a wound repair code when performing a percutaneous ventricular puncture or subdural tap," says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison. "The CCI edits were likely developed to preclude inappropriate unbundling of securing the entry site of the puncture with a suture and describing this as a wound repair. Closure is an inherent part of the surgical procedure."