Neurosurgery Coding Alert

Version 8.1 of the national Correct Coding Initiative (CCI) is available and remains active from April 1 to June 30, 2002. It contains no significant edit additions or deletions, but it does include several minor changes that affect neurosurgical practices.

CCI classifies coding edits into two categories: mutually exclusive code pairs and comprehensive/ component code pairs, explains Susan Callaway, CPC, CCS-P, an independent coding and reimbursement specialist and educator in North Augusta, S.C. Mutually exclusive procedures are those services/procedures "that cannot reasonably be done 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. One repair method must be chosen to repair the organ and must be reported," according to CCI. Such edits are arranged into "column 1" and "column 2" codes. Per CCI instructions, mutually exclusive codes are not "bundled" (i.e., procedures identified with column 1-codes are not included in or incidental to procedures identified with column 2-codes, or vice versa) but are not to be billed together due to conflicting CPT definitions for the two codes or the "medical impossibility/improbability that the procedures could be performed at the same session." In those cases in which codes identified as mutually exclusive are reported for the same patient encounter, generally only the lesser-valued (column 1) procedure will be recognized and reimbursed.

Comprehensive/component code pairs are the more familiar bundling edits, in which one procedure/service (identified as the component code) is a standard part of or incidental to a more complex or definitive procedure/service (identified as a comprehensive code) and, therefore, may not be reported or reimbursed separately. A common example in neurosurgical practice is bundling 20660 (Application of cranial tongs, caliper, or stereotactic frame, including removal [separate procedure])to 61793(Stereotactic radiosurgery [particle beam, gamma ray or linear accelerator], one or more sessions), says Stacey Lang, coding and physician reimbursement analyst at Allegheny General Hospital in Pittsburgh.

Because you can't perform stereotactic radiosurgery without placing the stereotactic frame, billing separately for 20660 with 61793 would be considered unbundling which could lead to an unreimbursed claim (at best) or audits and accusations of fraudulent coding (at worst).

Codes 22520 (Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic) and 22521 ( lumbar) now include +69990 (Micro-surgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]). This edit continues a trend in which use of the operating microscope is included as part of more and more neurosurgical procedures. In addition, 22521 and 22851 (Application of intervertebral biomechanical device[s] [e.g., synthetic cage(s), threaded bone dowel(s), methylmethacrylate] to vertebral defect or interspace) include anesthesia service 01905 (Anesthesia for myelography, diskography, vertebroplasty).

Edits involving nervous system/surgery codes are more extensive than those involving musculoskeletal codes, and the majority of the changes are new code pair edits. Deletions are minor and self-evident: Code 62284* (Injection procedure for myelography and/or computerized axial tomography, spinal [other than C1-C2 and posterior fossa]) no longer includes anesthesia services 01906 and 01908, which have been eliminated from CPT for 2002. Similarly, 62290-62292 (Injection procedure) no longer bundle anesthesia services 01912-01914 (which have also been eliminated from CPT).

Like 22521 and 22851, 61055* (Cisternal or lateral cervical [C1-C2] puncture; with injection of medication or other substance for diagnosis or treatment [e.g., C1-C2]) now includes 01905. Other procedures to bundle anesthesia services include 61624 (Transcatheter occlusion or embolization [e.g., for tumor destruction, to achieve hemostasis, to occlude a vascular malformation], percutaneous, any method; central nervous system), which bundles 01924 and 01926; 61626 ( non-central nervous system, head or neck [extracranial, brachiocephalic branch]), which bundles 01924; 62270* (Spinal puncture, lumbar, diagnostic) and 62272* (Spinal puncture, therapeutic, for drainage of cerebrospinal fluid [by needle or catheter], which bundle 00635; injection procedures 62280-62291, which bundle 01905; and 62294 (Injection procedure, arterial, for occlusion of arteriovenous malformation, spinal), which also bundles 01924.

HCPCS level II code G0173 (Stereotactic radiosurgery, complete course of therapy in one session) is now included in a host of procedures, including 61105, 61107, 61120-61151, 61250, 61253 and 61750-61770.

Codes describing surgery of intracranial arteriovenous malformations (61680-61711) include numerous and overlapping edits involving craniectomy/craniotomy codes 61304-61345 and others, as follows (the comprehensive code is listed first, with component codes after the colon):