Neurosurgery Coding Alert

National Technical Information Services (NTIS) has released version 8.2 of the national Correct Coding Initiative (CCI), which lists over 17,000 code-pair additions (i.e., new edits) and 3,700 code-pair deletions. The third-quarter revision went into effect July 1, 2002, and contains few changes for neurosurgeons.

Most revisions in version 8.2 of CCI involve the bundling of anesthesia procedures (00100-01999) to codes not typically reported by neurosurgery practices. Several changes including anesthesia codes will indirectly affect neurosurgeons, however.

For example, excision procedure 64784 (Excision of neuroma; major peripheral nerve, except sciatic) now bundles (i.e., includes as not separately reportable) administration-of-anesthesia codes 01320, 01470, 01610, 01710, 01782, 01810 and 01995. Excision codes 64788 (Excision of neurofibroma or neurolemmoma; cutaneous nerve), 67490 ( major peripheral nerve), 64792 ( extensive [including malignant type]) and biopsy code 64795 (Biopsy of nerve) now bundle all of the above anesthesia procedures, as well as 01250.

Similarly, neurorrhaphy procedures 64831, 64834-64836 and 64856-64857 now include therapeutic injection 20526 (Injection, therapeutic [e.g., local anesthetic; corticosteroid], carpal tunnel). Following this same pattern, injection codes 20551-20553 are now bundled to (i.e., included in) neurorrhaphy procedures 64861-64866 and 64868-64870, as well as neurorrhaphy with nerve graft procedures 64885 and 64890-64907.

Predictably, sympathectomy codes 64821-64823 now include use of microsurgical techniques (69990), continuing the trend whereby use of the operating microscope is separately reportable for fewer and fewer procedures.

Code 64450* (Injection, anesthetic agent; other peripheral nerve or branch) has now been bundled to codes 11981-11983, which describe the insertion, removal and reinsertion of nonbiodegradable drug delivery implants.

Relevant deletions in version 8.2 of the CCI are even fewer than additions: Injection procedure 62284 for myelography no longer includes codes 01906 and 01908, which were removed from CPT 2002. Similarly, injections 62290 and 62292 (for diskography and chemonucleolysis, respectively) no longer include 01912, and injection 62291 for diskography no longer bundles 01914. Other coding edits including no-longer-viable anesthesia codes and neurosurgical procedures (i.e., the bundling of 61026* [Ventricular puncture] to 00850) have also been included as deletions, but should have no effect if you are using an up-to-date version of CPT.