Neurosurgery Coding Alert

Rely on this comprehensive list of all new neurosurgery CPT^® changes.

If you're an experienced coder, then you're probably accustomed to associating the beginning of the new year with a brand-new set of specialty-specific CPT^® codes. Next year is no different, as 2018 offers another vast array of new, revised, and deleted codes.

From a neurosurgery perspective, next year incorporates a variety of coding changes. This year's CPT^® changes include new nerve repair with allograft codes, revisions to neurostimulator application and observational status evaluation and management (E/M) codes, among others.

Keep reading for a complete breakdown of all 2018 neurosurgery coding changes.

Get to Know 2 New Nerve Repair Codes

Beginning in January, CPT^® presents two codes for nerve repair with allograft. Consider the following two new codes:

• 64912, Nerve repair; with nerve allograft, each nerve, first strand (cable)
• 64913, Nerve repair; with nerve allograft, each additional strand (List separately in addition to code for primary procedure)

"These two new codes represent an expansion of the nerve repair codes when using a graft material," says Gregory Przybylski, MD, interim chairman of neurosurgery and neurology at the New Jersey Neuroscience Institute, JFK Medical Center in Edison.

"Previous codes in this series included autograft harvested from the patient to repair a gap in the transected nerve or using a conduit to allow a framework for the native nerve to grow through. This pair of codes describes use of nerve allograft, in contrast to autograft or conduit, in nerve repair. Microdissection is considered inclusive and not separately reportable," explains Przybylski.

Factor in These Revisions

The first revision to be aware of is a modified description of the code for the application of a transcutaneous neurostimulator. To clear any confusion on which types of nerve stimulation equipment this code entails, CPT^® provides the example of the commonly used transcutaneous electrical nerve stimulation (TENS) unit:

• 64550, Application of surface (transcutaneous) neurostimulator (eg, TENS unit)

On the subject of clarity, CPT^® revised their visual evoked potential (VEP) code to further specify its code description. Take a look at these changes to the code description for 95930:

• 95930, Visual evoked potential (VEP) checkerboard or flash testing, central nervous system except glaucoma, checkerboard or flash with interpretation and report

Essentially, the significant changes to be aware of with this revision are the inclusions of "except glaucoma" and "with interpretation and report."

When applying code 95930 in 2018, there will be no question as to whether the coder should include a separate interpretation and report code. Testing procedures typically include interpretation and creation of a report summarizing the test and findings. The clinical diagnosis of glaucoma is now specifically excluded from the CPT^® descriptor, as this procedure is not applicable to those with this condition.

Stay on Top of these E/M Revisions

Additionally, beginning in January, you will find a subtle, but important revision to all observation care discharge E/M codes. For the initial observation E/M codes 99217-99220 (Initial observation care, per day, for the evaluation and management of a patient...), you will see the inclusion of the term "outpatient hospital" to describe the patient's observation status. For example, a portion of the description for code 99217 will change to "this code is to be utilized to report all services provided to a patient on discharge from outpatient hospital 'observation status' if the discharge is on other than the initial date of "observation status.'"

Consider these Deleted Neurostimulator and nTMS Codes

Finally, you should be aware of these two important deletions, which take effect in January:

• 64565, Percutaneous implantation of neurostimulator electrode array; neuromuscular
• 0310T, Motor function mapping using non-invasive navigated transcranial magnetic stimulation (nTMS) for therapeutic treatment planning, upper and lower extremity