Neurosurgery Coding Alert

If you're trying to stay up to date with all the latest coding information, you don't want to miss these two items.

1. CMS Revises Bilateral Surgery Indicator for 64640

You'll want to keep an eye on any claims for 64640 (Destruction by neurolytic agent; other peripheral nerve or branch). CMS transmittal 558, released May 6, contains updates to the 2005 Physician fee schedule Database that change this injection procedure's bilateral surgery indicator from "0" to "1."
 
Good news: The change means that surgeons who perform 64640 can expect additional compensation for bilateral claims with modifier -50 (Bilateral procedure) appended. In the past, Medicare would not pay an increased fee for such bilateral injections. Based on the fee schedule update, however, surgeons can now expect 150 percent of the unilateral fee for bilateral injections reported using 64640-50.
 
CMS transmittal 558 outlines updated fee schedule information for several dozen CPT codes, although the only change specific to neurosurgery practices involves 64640.
 
Learn more: To view CMS transmittal 558, visit www.cms.hhs.gov/manuals/pm_trans/R558CP.pdf.

2. 2006 ICD-9 Changes Now Available

Beginning in October, neurosurgery practices will be able to use a new diagnosis code: V12.42 (Personal history, infections of the central nervous system). As with most other V codes, you probably won't use V12.42 as a primary diagnosis, but it could provide valuable secondary or signs-and-symptoms information, especially for diagnostic testing meant to establish a primary diagnosis of central nervous system (CNS) infection.
 
The May 4 Federal Register included a complete list of more than 140 new ICD-9 codes, along with over a dozen code deletions and 25 code revisions. These codes will become active Oct. 1, 2005. As in past years, the trend is toward greater and greater diagnosis specificity.
 
Adding specificity to diagnosis coding "is very much a conscious effort," says Amy Blum with the National Center for Health Statistics at the Centers for Disease Control and Prevention, which designs the ICD-9 codes.
 
In spite of the strides being made toward diagnosis availability, with the possible exception of the inclusion of V12.42, neurosurgeons won't feel much impact in the coming year. That's because the changes are more specific to other specialties, including bariatric surgery, centers treating sleep disorders, and others.
 
Learn more: You can find a complete list of the new, deleted and revised ICD-9 codes in tables 6A, 6C and 6E of the May 4 Federal Register, available online at www.access.gpo.gov/su_docs/fedreg/a050504c.html. Scroll down to "Centers for Medicare & Medicaid Services" and "Proposed Rules" to find the link.