Neurosurgery Coding Alert

As discussed elsewhere in this issue (see -Check These 5 Items to Apply Modifier 57 Properly- on page 75), you should append modifier 57 (Decision for surgery) when the surgeon performs a significant and separate E/M service within 24 hours prior to, and which results in, any surgical procedure with a 90-day global period.

In answer to a Reader Question (-Leave Modifier 50 Off Decompression Claim-), Neurosurgery Coding Alert Vol. 8, No. 7, page 55 erred by stating that you should append modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to a level-three E/M service that prompted a spinal decompression, as reported by 63047 (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; lumbar) and +63048 (... each additional segment, cervical, thoracic or lumbar [list separately in addition to code for primary procedure]), for spinal stenosis (724.02, Spinal stenosis, lumbar region).

In fact, because the primary procedure 63047 is a major surgical procedure with a 90-day global period, you should append modifier 57, rather than modifier 25, to the E/M service (99213, Office or other outpatient visit for the evaluation and management of an established patient ...).

Many thanks to sharp-eyed reader Gwen Flaherty, CPC, of Neuroscience Associates in Boise, Idaho, for pointing out the error.