Neurosurgery Coding Alert

Bonus: Here's how anatomical modifiers can bolster your claim. Adding modifiers such as 59, 22, and 79 can make a huge reimbursement difference to your brain tumor excision and hematoma evacuation claims. Think you know how to apply them correctly? Our experts answer the scenarios presented on page 83. Stick to 1 Code for Incidental Evacuations Solution 1: For brain tumor excision, you should select 61510 (Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except meningioma). This procedure includes any "incidental" hematoma evacuations at the same location, says Michelle L. Benz, billing supervisor at a neurosurgery and spine practice in Milwaukee, Wis. In other words: You would not report 61312 (Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural) in addition to 61510 for evacuation of hematoma at the site of the
tumor removal. The Correct Coding Initiative (CCI) supports this coding convention by expressly bundling 61312 into 61510, says Judy Montgomery, CPC, neurosurgery revenue cycle coordinator at UPMC in Pittsburgh. Look at it this way: Because the surgeon easily accessed the hematoma via the same craniectomy, you should report only the tumor excision (61510). Separate Site? Slap Mod 59 Onto Second Code Solution 2: First of all, you should note that in cases when the surgeon must perform a separate surgical approach (that is, a second craniectomy or craniotomy) to access the site of the hematoma, you may report both the tumor excision and the hematoma evacuation, Benz says. Why? Because the hematoma evacuation adds time and difficulty to the procedure, the surgeon may expect additional compensation. What this means: When reporting a separate tumor excision and hematoma evacuation, you must append modifier 59 (Distinct procedural service) to the "bundled" procedure -- in this case, the hematoma evacuation (61312). By appending modifier 59, you alert the payer that you are overriding the CCI edit bundling these procedures because the tumor and hematoma occur at distinct, separate locations, Montgomery says. Bonus tip: When the situation allows, you can also append HCPCS modifiers LT (Left side) and RT (Right side) to enhance the specificity of your claim and further support separate payment for hematoma evacuation and tumor excision. In this case, you should report 61510 for the tumor excision and 61312 for the hematoma evacuation. Append modifier 59 to 61312 to designate the distinct nature of the procedure. To further differentiate the separate locations of the two procedures, you can also append modifier LT to 61510 and modifier RT to 61312 (61510-LT, 61312-59-RT). Best advice: To avoid payment delays, file the claim manually and include a copy of the operative report, along with a letter describing the circumstances of the surgery and the separate, distinct nature [...]