Neurosurgery Coding Alert

Changes affecting neurosurgery will generally clarify or narrow previous definitions. In most cases, the revised descriptors do not affect how the codes are applied.
 
Although only time will tell how CMS and private payers will respond to the revisions, practices should begin preparing now. CPT 2002 becomes effective Jan. 1, but not all payers (whether Medicare or private) adopt changes uniformly. Check with your insurer before billing any of the new or revised codes.
 
Skull, Meninges and Brain: 61000-62258
Code revisions affecting neurosurgery are limited primarily to the nervous system/surgery portion of CPT (60000 series), with no big changes in the musculoskeletal system/surgery portion (20000 series). 
 
Injection, drainage or aspiration codes 61026 and 61055 include new terminology, replacing "drug" with "medication" in the descriptors (new text is in bold type):

61026* ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; with injection of medication or other substance for diagnosis or treatment.

61055* cisternal or lateral cervical (C1-C2) puncture; with injection of medication or other substance for diagnosis or treatment (e.g., C1-C2).
As starred procedures, 61026 and 61055 include no global period. If a starred procedure is performed at the time of an initial or established patient visit involving significant identifiable services, the appropriate visit (e.g., 99213, office or other outpatient visit for the evaluation and management of an established patient) should be reported with modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).
 
The abbreviation "CSF" in the descriptor for 61618 has been replaced by "cerebrospinal":

61618 secondary repair of dura for cerebrospinal fluid leak, anterior, middle or posterior cranial fossa following surgery of the skull base; by free tissue graft(e.g., pericranium, fascia, tensor fascia lata, adipose tissue, homologous or synthetic grafts).
Note: For more information on billing skull base surgeries, including approaches and secondary dural repair, see Neurosurgery Coding Alert, October and November 2001.
 
Repair/replacement codes 62100, 62230, 62252, 62256 and 63707 (a spinal procedure) undergo the same change as 61618:

62100 craniotomy for repair of dural/cerebro-spinal fluid leak, including surgery for rhinorrhea/otorrhea.

62230 replacement or revision of cerebrospinal fluid shunt, obstructed valve, or distal catheter in shunt system.

62252 reprogramming of programmable cerebrospinal shunt.

62256 removal of complete cerebrospinal fluid shunt system; without replacement.

63707 repair of dural/cerebrospinal fluid leak, not requiring laminectomy.
Spinal Procedures: 62263-63746
The descriptor for 62272 has undergone a slight revision:

62272 spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter). 
 
Previously, the descriptor less-specifically indicated "for drainage of spinal fluid." The change will not affect the code's use.
Extracranial and Peripheral Nerves: 64400-64907
Neurostimulator codes 64555 and 64575 specifically exclude the sacral nerve. New codes have been [...]