Neurosurgery Coding Alert

Key: Apply these add-ons and watch your modifier 51 use.

When reporting add-on codes, for your surgeon's cranial and spinal work, you'll stand a much better chance of recouping full reimbursement if you follow three crucial guidelines.

1. Don't Miss the Primary Procedure

Remember that an add-on code cannot be a standalone code. You will need an accompanying primary procedure code to fully account for the additional intraservice work that your clinician does in a single session or patient encounter.

Example: Look at the codes below for percutaneous vertebral augmentation.

• 22524 - Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, 1 vertebral body, unilateral or bilateral cannulation (e.g., kyphoplasty) lumbar
• 22523 - Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, 1 vertebral body, unilateral or bilateral cannulation (e.g., kyphoplasty) thoracic
• 22525 - Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, 1 vertebral body, unilateral or bilateral cannulation (e.g., kyphoplasty) each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure)

You will see that the code 22525 clearly specifies that it needs to be separately listed in addition to the code for the primary procedure.

Similarly, the codes for the vertebroplasty are location specific. Also note that you report only a single unit of a primary code per operative session.

Example: You report 22520 (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection; thoracic) for vertebroplasty at a single level between T1-T12 or 22521 (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection; lumbar) for a single level between L1-L5.

When you read that your surgeon treated another level in the thoracic or lumbar regions, you would also report +22522 (Percutaneous vertebroplasty [bone biopsy

Example: You do not bill 69990 appended with the 51 modifier in one single operative session. In other words, you report only one unit of +69990 without a modifier, regardless of how many times your surgeon uses the operating microscope in a single session.

CPT® clearly specifies "All add-on codes found in the CPT book are exempt from the multiple-procedure concept."

Earn Your Deserved Payment

You report an add-on code with the designated code(s) for a primary procedure to imply a correct and complete description of the procedure your surgeon does. This will get you your much deserved payment as well.

For a craniotomy that your surgeon does, you may report microdissection as add-on to specify the use of the operating microscope in the operative session. "In addition, report the microdissection code 69990 immediately after the primary procedure code to enhance the likelihood of proper payment," says Przybylski.

Make sure your payment is in accordance to the fee schedule rate. Note that the fee schedule amounts assigned to add-on codes already reflect their status as "additional procedures." The logic of reduction of payment for the second and other following procedures when the surgeon does multiple procedures does not apply to the add-on procedures. You can go ahead and appeal your claims if your payment has been reduced or denied for an add-on code. You can cite in support the CPT® definition of add-on codes as 'additional procedures exempt from modifier 51 rules.'