Neurosurgery Coding Alert

Version 8.0 of the national Correct Coding Initiative (CCI) went into effect Jan. 1, 2002, and will remain active until March 31. The edits are mandatory for all Medicare carriers, and are increasingly observed by third-party payers as well. Of the approximately 8,400 changes (total additions and deletions in all code categories), only a few affect neurosurgeons.
 
CCI groups edits into two categories: Comprehensive/Component and Mutually Exclusive. Comprehensive/component edits describe procedures (component codes) that are considered included as a part of or incidental to (i.e., bundled) a more extensive procedure (the comprehensive code) and therefore should not be reported separately.
 
According to CCI, mutually exclusive edits describe codes that cannot reasonably be performed in the same session. An example of a mutually exclusive situation is when the repair of the organ can be performed by two different methods, CCI explains. Only one method of repair may be chosen because to report both would represent an unfeasible circumstance.
 
During each quarter, CCI adds or deletes code combinations (i.e., creates new edits or nullifies previous edits) from the comprehensive/component or mutually exclusive categories.

Comprehensive Code Additions

 
Changes in this area involve mainly radiology codes and a few nervous system/surgery edits. Although CCI 8.0 contains edits affecting musculoskeletal codes (20000-29999), none of these code pairs apply to neurosurgery.
 
Most significantly, laminectomy procedures 63001
( with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy, [e.g., spinal stenosis], one or two vertebral segments; cervical) and 63015 (laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy, [e.g., spinal stenosis], more than two vertebral segments; cervical) are now bundled to craniectomy procedure 61343 ( suboccipital with cervical laminectomy for decompression of medulla and spinal cord, with or without dural graft [e.g., Arnold-Chiari malformation]).
 
Similarly, version 8.0 includes laminotomy 63020 ( [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, cervical) in 63045 (laminectomy, facetectomy and foraminotomy [unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (e.g., spinal or lateral recess stenosis)], single vertebral segment; cervical).
 
Angiography codes 70496 ( head), 70498 ( neck) and 70542-70549 (magnetic resonance) bundle nine codes each, ranging from 36000 to 90784. Once again, these edits will have limited impact. In either of these situations, however, modifier -59 (distinct procedural service) should be used to override the edits if the laminotomy or laminectomy is performed at nonadjacent levels.

 
The majority of edits in this area involve nervous system/surgery codes. Few are substantial. Injection codes 62280-62284 (injection/infusion of neurolytic substance [e.g., alcohol, phenol, iced saline solutions], with or without other therapeutic substance), 62310-62311 (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) and 62318-62319 (injection, including catheter placement, continuous infusion or intermittent bolus) are now included in a host of anesthesia codes (00797-01969). Introduction/injection codes 64400-64470, 64475, 64479, 64483 and 64505-64560 are likewise now bundled to many of these same anesthesia codes. However, neurosurgeons would not normally report such procedures separately.
 
No Additional Changes 
 
 
CCI version 8.0 contains no mutually exclusive code pair edits (either additions or deletions) or comprehensive/component deletions affecting codes commonly used by neurosurgeons. Nevertheless, neurology practices should keep pace with CCI changes each quarter because, however minor, such changes dictate proper coding per Medicare guidelines.
 
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 www.ntis.gov/products/hcfa.htm) for more information.