Neurosurgery Coding Alert

For 2004, CPT brings a number of welcome code additions, as well as a few clarifications and small guideline changes. Overall, these refinements should help  neurosurgeons and their coders report services with greater accuracy and less confusion. Radiofrequency Ablation Adds an Option to Excision Neurosurgeons now have an alternative to open excision procedures when removing or destroying tumors in hard-to-reach places such as the cervical spine or skull base. Code 20982 (Ablation, bone tumor[s] [e.g., osteoid osteoma, metatasis] radiofrequency, percutaneous, including computed tomographic guidance) describes the use of microwaves to ablate tumors of the bone.
 
"Neurosurgeons already use the radiofrequency technique for lesioning of the facial nerve [for instance, 64600], and now those who have adopted this technique for destroying bone tumors have a CPT code to report the service," says Eric Sandham, CHC, CPC, compliance manager for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno. New Codes Distinguish Extracavitary From Other Approaches CPT now includes codes specifically to describe arthrodesis by lateral extracavitary technique: 22532 (Arthrodesis, lateral extracavitary technique, including minimal diskectomy to prepare interspace [other than for decompression]; thoracic), 22533    (... lumbar) and +22534 (... thoracic or lumbar, each additional vertebral segment [list separately in addition to code for primary procedure]). These new codes will allow surgeons to differentiate the extracavitary technique from other approaches, such as anterolateral (22548-22556) or posterior (22590-22614). The greater specificity of CPT means that surgeons will have to be more careful than ever to document the approach they use during arthrodesis procedures, however.
 
Along with 22532-22534, CPT adds three new codes to describe vertebral corpectomy by lateral extracavitary approach: 63101 (Vertebral corpectomy [vertebral body resection], partial or complete, lateral extracavitary approach with decompression of spinal cord and/or nerve root[s] [e.g., for tumor or retropulsed bone fragments]; thoracic, single segment), 63102 (... lumbar, single segment) and +63103 (... thoracic or lumbar, each additional segment [list separately in addition to code for primary procedure]). You may report these codes, for instance, if the surgeon must perform more than "minimal diskectomy" along with 22532-22534.

New Lobectomy Codes Increase Specificity For 2004, CPT features two new and two revised lobectomy codes (revised text is in bold):

61537 - Craniotomy with elevation of bone flap; for lobectomy, temporal lobe, without eletrocorticography during surgery
61538 - ... for lobectomy, temporal lobe, with eletrocorticography during surgery
61539 - ... for lobectomy, other than temporal lobe, partial or total, with eletrocorticography during surgery
61540 - ... for lobectomy, other than temporal lobe, partial or total, without eletrocorticography during surgery "The new codes permit surgeons to perform a lobectomy, temporal or otherwise, for resection of an epileptogenic focus rather than [...]