Neurosurgery Coding Alert

"The new codes permit surgeons to perform a lobectomy, temporal or otherwise, for resection of an epileptogenic focus rather than for a tumor, and allow for resections with and without eletrocorticography," says R. Patrick Jacob, MD, a neurosurgeon with the University of Florida

More Codes Describe Selective Deep-Brain Surgery 

Two new codes describe selective removal of deep- brain structures: 61566 (Craniotomy with elevation of bone flap; for selective amygdalohippocampectomy) and 61567 (... for multiple subpial transections, with electro-corticography during surgery).
 
Specifically, 61566 describes selective resection of isolated structures in the mesial temporal lobe without resection of the entire lobe. Previously, you would have reported such procedures using a lobectomy code (such as 61538-61539) with modifier -52 (Reduced services).
 
Code 61567 details a procedure in which the surgeon "disconnects" (transects) abnormal neurons to prevent the spread of abnormal electrical activity. The surgeon does not remove cerebral tissue.
 
Four Codes Replace All-in-One Implantation Code

CPT had deleted 61862, which described implantation of neurostimulators, and replaced it with four more precise codes:

Previously, when the surgeon used intraoperative microelectrode recording during stimulator implantation, he would bill separately using 95961 (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) and, if necessary, +95962 (... each additional hour of physician attendance [list separately in addition to code for primary procedure]). The addition of 61867-61868 clarifies that a separate charge for the microelectrode analysis is appropriate only when performed by another physician (such as a neurologist).
 
And, "each additional" codes 61864/61868 should ease coding for multiple electrode arrays. "Until this year, if the surgeon implanted multiple arrays, the coder would have to report multiple units of 61862, usually with modifier -51 [Multiple procedures] appended. Now, the coder may simply select as many units as necessary of the 'each additional' codes," Sandham says.

Multilevel Lamis Are Unilateral

A text change accompanying laminotomy (hemilaminectomy) confirms that additional levels of laminotomy (63035) are unilateral procedures, and that coders should attach modifier -50 (Bilateral procedure) to this code if the surgeon performs laminotomy on each side of the spine.
 
"This was something everybody already knew, for the most part, but the text change confirms it," Sandham says.
 
Destruction Procedures Include More Nerves

CPT 2004 brings a new nerve block code: 64449 (Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration).
 
"Here again, I think CPT is trying to distinguish a less extensive procedure - placement of a catheter in the lumbar plexus [64449] - to prevent it from being miscoded as a more extensive procedure. In this case, the procedure is the injection of diagnostic or therapeutic substances to the epidural or subarachnoid space, as described by 62318 and 62319," Sandham says.
 
CPT also includes an additional sympathetic nerve in the list of nerves to which the surgeon may administer a block (64517, Injection, anesthetic agent; superior hypogastric plexus) or which he may destroy by neurolytic agent (64681, Destruction by neurolytic agent, with or without radiologic monitoring; superior hypogastric plexus).