Neurosurgery Coding Alert

A number of codes that affect neurosurgeons have been added, deleted or changed in CPT 2000. For example, codes for neurostimulator procedures in particular have become more descriptive, which should help to clarify proper billing for vagal nerve stimulators (VNS). Another major change concerns 61795. Previously, this code described an intracranial procedure. Its new expanded definition now encompasses intracranial, extracranial and spinal.

New Wording From CPT 2000

Several code definitions have been altered in CPT 2000 that should interest neurosurgeons.

22630. CPT 2000 defines 22630 as arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace (other than for decompression), single interspace; lumbar. This is a significant clarification. Until 2000, the CPT definition for 22630 did not include the laminectomy and/or the diskectomy. Consequently, neurosurgeons billed separately for these procedures and faced denials. In the CCI Correct Coding Initiative, however, these procedures were bundled into 22630. The CPT and CCI now agree.

61751. Code 61751 now is defined as stereotactic biopsy, aspiration, or excision, including burr holes(s), for intracranial lesion; with computerized axial tomography and/or magnetic resonance guidance. This code is used for stereotactic brain biopsies and other surgeries performed with neuronavigational equipment. Only CT scans were recognized previously. The addition of magnetic resonance imaging reflects the use of current technology.

61795. CPT 2000 defines 61795 as stereotactic computer assisted volumetric (navigational) procedure, intracranial, extracranial, or spinal (List separately in addition to code for primary procedure). This code has been used strictly for cranial procedures in the past. Now this procedure can be used for observation and location in the extracranial and spinal areas.

61885. Code 61885 is defined as incision and subcutaneous placement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array. With the placement of certain neurostimulator pulse generators or receivers there may be a single electrode array or a multiple array required. This code has been defined more strictly in CPT 2000 to indicate use for a single array only, while 61886 has been added for connection to two or more electrode arrays.

62273. Code 62273 is defined in CPT 2000 as injection, epidural, of blood or clot patch. This injection generally is required in the wake of a spinal tap if there is a cerebral spinal fluid leak and headaches result. This code now may be used for any part of the spine, whereas it previously could be used only if the injection occurred in the lumbar region of the spine.

62280. CPT 2000 designates 62280 for injection/infusion of neurolytic substance (e.g., alcohol, phenol, iced saline solutions), with or without other therapeutic substance; subarachnoid. This injection generally is given when the neurosurgeon must numb or destroy a nerve, to treat a tic or other malady. The revision allows the use of other substances in addition to the neurolytic agent.

62282. Codes 62281 (epidural, cervical or thoracic) and 62282 (epidural, lumbar, sacral [caudal]) branch from 62280 and refer to the area treated. The altered definition of 62282 indicates another region to which the injection may be given.

62287. In the new CPT, 62287 is defined as aspiration or decompression procedure, percutaneous, of nucleus pulposus of intervertebral disk, any method, single or multiple levels, lumbar (e.g., manual or automated percutaneous diskectomy, percutaneous laser diskectomy). This procedure removes excess fluid from a disk to decompress the nerve root. The new language in this code expands and clarifies the procedures reimbursable perimeters, including the associated forms of diskectomy.

62291. Code 62291 (cervical or thoracic) branches from 62290 (injection procedure for diskography, each level; lumbar). The change expands the number of regions to which this injection may be given.

62350. Code 62350 is defined as implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term pain management via external pump or implantable reservoir/infusion pump; without laminectomy. This clarification recognizes the full scope of use that has been ongoing with this procedure.

63030. CPT 2000 defines 63030 as laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar (including open or endoscopically-assisted approach). This code has been revised to clarify appropriate reporting when performing a laminectomy for disk removal endoscopically.

63056. Code 63056 (lumbar [including transfacet, or lateral extraforaminal approach] [e.g., far lateral herniated intervertebral disk]) branches from 63055 (transpedicular approach with decompression of spinal cord, equina and/or nerve root[s] [e.g., herniated intervertabral disk] single segment; thoracic). This is a significant improvement over CPT 1999 because previously neurosurgeons had to bill 63030 with modifier -22 (unusual procedural services) for this far lateral procedure. With CPT 2000, 63056 has a higher relative value unit (RVU) than 63030 and no modifier
is necessary.

64622. The CPT 2000 definition of 64622 (destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level) clarifies CPT language that made this procedure appear to be a subset of intercostal nerve (64620). The number of applicable regions also has been expanded.

64623. Code 64623 (lumbar or sacral, each additional level [list separately in addition to code for primary procedure]) branches from 64622 and is used for additional levels. The number of applicable regions has been expanded.

95816 and 95819. CPT 2000 defines 95816 as electroencephalogram (EEG) including recording awake and drowsy (including hyperventilation and/or photic stimulation when appropriate) and 95819 as electroencephalogram (EEG) including recording awake and asleep (including hyperventilation and/or photic stimulation when appropriate). The addition of the phrase when appropriate to these codes is a signal to neurosurgeons that they should include notes documenting the medical necessity of hyperventilation and/or photic stimulation.

95831. Code 95831 (muscle testing, manual [separate procedure] with report; extremity [excluding hand] or trunk) is used when the neurosurgeon tests a patient for carpal tunnel syndrome and other conditions. It is also used for nerve conduction testing. At times, electromyograms (EMG) are performed to locate muscles for injections and no report would be given. This code may not be appropriate for such use.

95870. Code 95870 (limited study of muscles in one extremity or non-limb [axial] muscles [unilateral or bilateral], other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters) is a subset of 95869 (needle electromyography thoracic paraspinal muscles). This new definition reflects the full range of applicable areas for which neurosurgeons can use the code.

95900. CPT 2000 defines 95900 as nerve conduction, amplitude and latency/velocity study, each nerve; any/all site(s) along the nerve (deleted) motor, without F-wave study. In the past, when a nerve conduction study was conducted on one nerve, no matter how many sites, only that one nerve was billable. This new language allows more test sites on one nerve to be charged, particularly if the nerve branches.

95904. Code 95904 (sensory or mixed) is a subset of 95900. The testing of mixed nerves has been added.

95961. Code 95961 is defined as functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; initial hour of physician attendance. Previously, confusion existed regarding the appropriate use of this code for functional cortical and subcortical mapping. Now both are explicitly covered.

95970. The definition of 95970 (electronic analysis of implanted neurostimulator pulse generator system [e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements]; simple or complex brain, spinal cord, or peripheral [i.e., cranial nerve, peripheral nerve, autonomic nerve, neuromuscular] neurostimulator pulse generator/transmitter, without reprogramming) has been expanded to include more applicable areas.

95971-95973. Codes 95971 (simple brain, spinal cord, or peripheral [i.e., peripheral nerve, autonomic nerve, neuromuscular] neurostimulator pulse generator/ transmitter, with intraoperative or subsequent programming), 95972 (complex brain, spinal cord, or peripheral [except cranial nerve] neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, first hour), and 95973 (complex brain, spinal cord, or peripheral [except cranial nerve] neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour [list separately in addition to code for primary procedure]) branch from 95970 and carry similar expanded definitions.

Critical Care Code Terminology Revised

CPT 1999 defined critical care code 99291 as critical care, evaluation and management of the unstable critically ill or unstable critically injured patient, requiring the constant attendance of the physician; first hour. Insurance companies often would argue over whether a critical care patient was stable or unstable and use this as grounds for reimbursement denials. But CPT 2000 defines the critical care code 99291 as critical care, evaluation and management of the critically ill or critically injured patient; (requiring the constant attendance of the physician deleted) first 30-74 minutes. The elimination of unstable from this language removes this billing dilemma.

This code previously was used for the first hour and the constant attendance of the physician was required. Now it can be used for the first 30-74 minutes. The add-on code 99292 may be used for each additional 30 minutes of critical care.

Modifier Revised

Modifier -32 has been revised in CPT 2000 to mean mandated services: services related to mandated consultation and/or related services (e.g., PRO, third party payer, governmental, legislative or regulatory requirement) may be identified by adding the modifier
-32 to the basic procedure or the service may be reported by use of the five-digit modifier 09932.

Previously, this modifier was used when an insurance company required a second opinion. The definition has been broadened to encompass second opinions required by governmental and regulatory agencies. For example, another neurosurgeon in your area has recommended that a patient undergo spine surgery, but the insurance company requires a second opinion. When billing for this consultation, the neurosurgeon should use modifier -32.

Codes Added

CPT 2000 also has added several codes to reflect changes in neurosurgery. These include:

61862stereotactic implant of neurostimulator array

61886placement of cranial neurostimulator device

62263lysis of epidural adhesions

62310epidural or subarachnoid injection

62311epidural or subarachnoid injection

62318epidural or subarachnoid injection with
indwelling catheter

62319epidural or subarachnoid injection with
indwelling catheter

64470paravertebral cervical or thoracic facet
joint/nerve injection

64472paravertebral cervical or thoracic facet
joint/nerve injection add-on code

64475paravertebral lumbar or sacral facet
joint/nerve injection

64476paravertebral lumbar or sacral facet
joint/nerve injection add-on code

64479transforaminal cervical or thoracic epidural
injection

64480transforaminal cervical or thoracic epidural
injection add-on code

64483transforaminal lumbar or sacral epidural
injection

64484transforaminal lumbar or sacral epidural
injection add-on code

64626paravertebral facet joint nerve destruction

64627paravertebral facet joint nerve destruction
add-on code


Codes Deleted

The following codes have been deleted in CPT 2000. The new code for the procedure has been added after the definition.

61855subcortical, use 61862

61865subcortical, use 61862

62274injection of diagnostic or therapeutic anesthetic or antispasmodic substance (including narcotics); subarachnoid or subdural, single, use 62310 or 62311

62275epidural, cervical or thoracic, single, use 62310

62276subarachnoid or subdural, differential, use 62318 or
62319
62277subarachnoid or subdural, continuous, use 62318 or 62319

62278epidural, lumbar or caudal, single, use 62311

62279epidural, lumbar or caudal, continuous, use 62319

62288injection of substance other than anesthetic,
antispasmodic, contrast, or neurolytic solutions; subarachnoid (separate procedure), use 62310 or 62311

62289lumbar or caudal epidural (separate procedure), use
62311

62298injection of substance other than anesthetic, contrast, or neurolytic solutions, epidural, cervical or thoracic (separate procedure), use 62310

64440paravertebral nerve (thoracic, lumbar, sacral, coccygeal), single vertebral level, use 64479 or 64483

64441paravertebral nerves, multiple levels (e.g., regional
block), use 64480 or 64484

64442paravertebral facet joint nerve, lumbar, single level, use 64475

64443paravertebral facet joint nerve, lumbar, each
additional level (list separately in addition to code for primary procedure), use 64476