Neurosurgery Coding Alert

The national Correct Coding Initiative (CCI), first issued in January 1996 and updated each quarter since, has become an essential source of coding information. "If you perform more than one procedure during the same session, you have to check if they are bundled. For that you need the most recent edition of the CCI," says Susan Callaway, CPC, CCS-P, an independent coding and reimbursement specialist and educator in North Augusta, S.C. "Relying on an outdated edition of CCI is like relying on last year's CPT. You don't know when CCI will add hundreds, even thousands, of new code pairs."
 
CCI code pairs are defined as either "incidental" or "mutually exclusive." Incidental services/procedures ("component" codes) are considered a part of another, more extensive service/procedure ("comprehensive" codes). A procedure or service is not normally separately reimbursable if reported with a comprehensive code into which it is bundled. A single procedure or service may be both a comprehensive code and a component code. For instance, injection code 62310 (injection, single & of diagnostic or therapeutic substance[s]) bundles eight component codes, including 69990 (operating microscope) but is itself a component of dozens of codes (for example, a majority of the injection, drainage or aspiration codes, 62263-62319). Thus, 69990 is also indirectly bundled into 62310.
 
Note: A complete explanation of Medicare bundling policies is in section 15010 of the Medicare Carriers' Manual (MCM). The MCM can be downloaded free from the Centers for Medicare & Medicaid Services (CMS, formally HCFA) Web site at http://www.hcfa.gov/ pubforms/progman.htm. Select the publication titled "Carrier Manual."
 
Mutually exclusive code pairs represent procedures/ services that, based on standard medical practice or CPT guidelines, usually cannot be performed "at the same session by the same provider on the same patient," CMS says. These code pairs are divided into "column 1" and "column 2" designations. The codes in column 2 represent the procedures/services that cannot be performed in the same session as the procedure/service listed in column 1, according to CCI. For instance, a surgeon would not perform a ventriculocisternostomy (62180) with placement of a subdural (62190) or ventriculo-auricular shunt (62220) during the same session.
 
All component and column 2 codes include a Correct Coding Edit Modifier Indicator, usually a "0" or "1." CCI says a 0 "indicates that there are no circumstances in which a modifier would be appropriate. The services represented by the code combination will not be paid separately." These code combinations may never be unbundled.
 
On the other hand, a "1" indicates "that a modifier is allowed & to differentiate between the services provided." In most cases, modifier -59 (distinct procedural service) is appropriate to unbundle CCI edits and allow for separate payment. In accordance with Medicare policy, however, "Modifier -59 should be used only when no more descriptive modifier (such as an anatomic modifier or the staged-procedure modifier) is available." For instance, if the neurosurgeon performs a laminectomy with foraminotomy (63047, ... unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] ... lumbar), with a hemilaminectomy and diskectomy at a different level (63030, ... with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar ...), modifier
-59 is appropriately appended to 63030 to indicate that the two procedures, normally not billed together, were performed at different locations in the body.
 
Note: The CCI is available by subscription from the National Technical Information Service (NTIS) in print or as a CD-ROM in searchable (.pdf) format. Contact NTIS (1-800-363-2068 or http://www.ntis.gov/products/hcfa.htm) for more information.