Neurosurgery Coding Alert

The latest version of the national Correct Coding Initiative (CCI, 7.2), effective July 1, 2001, bundles injection codes with nearly all the spinal codes in the Surgery/Musculoskeletal System and Surgery/Nervous System portions of CPT. Edits were also made to the incision codes 49000 and 49002, bundling them into spinal-procedure codes.

Injection Codes Bundled
  
 The following injection codes were bundled:

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)
 

62311 (... lumbar, sacral [caudal])
 

62318 (injection, including catheter placement, continuous infusion or intermittent bolus, 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)
 

62319 (... lumbar, sacral [caudal]). 
 
 

In each case, the edits include a "1" superscript to indicate that modifier -59 (distinct procedural service) may, under appropriate circumstances, be appended to the injection code to bill it separately. 
 

Codes 62310-62319 were often applied when the surgeon injected anesthesia into the vertebral interspace during surgery to improve postoperative pain management. By bundling these codes into spinal surgery procedures, CCI is disallowing separate reimbursement for them. Rather, these codes are appropriately reported when the injections are performed percutaneously.
 

Although unlikely, if an injection is provided during surgery at a level not addressed operatively, modifier -59 may be appended to the injection code to indicate that the procedure was performed at a different area of the body and should be separately reimbursed.

Incision codes 49000 (exploratory laparotomy, exploratory celiotomy with or without biopsy[s] [separate procedure]) and 49002 (reopening of recent laparotomy) have also been bundled into a variety of spinal-procedure codes in the 22114-22855 and 63087-64809 ranges. The bundles are perhaps an attempt to prevent separate (and inappropriate) billing for an approach performed by a general surgeon prior to definitive treatment by the neurosurgeon. If this reasoning applies, however, the edits will not achieve the desired result, says Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno. "A general surgeon billing for the approach will likely misreport 49010 (exploration, retroperitoneal area with or without biopsy[s] [separate procedure]) before 49000 or 49002. 

"The approach is included in the procedure," Sandham continues. "If a different surgeon performs the approach, both surgeons should bill the primary-procedure code(s) with modifier -62 (two surgeons) attached. The laparotomy codes should not be used." 

Codes 22318 (open treatment and/or reduction of odontoid fracture[s] and/or dislocation[s] [including os odontoideum], anterior approach, including placement of internal fixation; without grafting) and 22319 (... with grafting) bundle 22 procedures, including application of cranial halo (20661), bone grafts (20931, 20937 and 20938), vertebral fracture repairs (22305, 22310 and 22315), injections (62310 and 62318, discussed above, and 64479) and use of the operating microscope (69990). Exploration of penetrating wound (20100), several casting procedures (29000-29715) and active wound-care management (97601, selective debridement) are also bundled, although it is unlikely that these would be performed with open treatment of odontoid fracture(s).