Neurosurgery Coding Alert

You'll no longer have to rely solely on 10180

You can begin using several new CPT^®codes, including two for incision and drainage procedures, one for intracranial angioplasty, and three vasospasm procedure codes. Our experts explain how the new codes will allow you to more accurately report the procedures your neurosurgeon performs.

 

22010, 22015 Better Represent I&D Procedures

 

CPT^®2006 adds two codes for incision and drainage procedures: 22010 (Incision and drainage, open, of deep abscess [subfascial], posterior spine; cervical, thoracic, or cervicothoracic) and 22015 (... lumbar, sacral, or lumbosacral).
 
 In 2005 the only code youhad to use for a post-operative incision and drainage (I&D) procedure was 10180 (Incision and drainage, complex, postoperative wound infection). For a non-postoperative I&D procedure, you would use 10061 (Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; complicated or multiple). For example, if the neurosurgeon must re-open and drain a patient's wound due to a post-laminectomy infection, you would report code 10180.

The descriptor for 10180 specifies ‘complex.’ You’ve been forced, however, to use 10180 for both complex spinal I&D procedures and relatively simple ones that may not even be near nerve roots. You may have tried appending modifier 22 (Unusual procedural services) to 10180, but even that was not a perfect solution.

With the two new codes, you’ll be able to differentiate the complexity and class of the I&D procedures your neurosurgeon performs. “I think it's great that there are new I&D codes for the back to allow physicians the opportunity to capture appropriate revenues for care of postoperative and/or post-traumatic wounds,” says Nancy L. Reading, RN, BS, CEO of CedarEdge Medical in Draper, Utah.

Caution: Remember to append modifier 78 (Return to the operating room for a related procedure during the postoperative procedure) to either 22010 or 22015 when your neurosurgeon performs the I&D procedure post-operatively during the global surgical period of another procedure. This shows the carrier that the I&D procedure was related to the original surgical procedure that your neurosurgeon performed.

Be sure that you assign an appropriate ICD-9 code for the postoperative wound infection as well, Reading says. Use the appropriate ICD-10 code once that code set is implemented.

 

Intracranial Angioplasty Codes Mirror Coronary Procedure

 

If your neurosurgeon performs balloon angioplasties, a specialized interventional radiological procedure, you’ll have a new code to report the procedure: 61630 (Balloon angioplasty, intracranial [e.g., atherosclerotic stenosis], percutaneous). Another new code that some neurosurgeons will want to start using is 61635 (Transcatheter placement of intravascular stent[s], intracranial [e.g., atherosclerotic stenosis], including balloon angioplasty, if performed).

“These are for a very specialized neurosurgical practice that would be doing this kind of interventional radiology and transcatheter intervention,” says Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery in New York City. These codes are an adaptation of what was a common cardiac procedure, which involves inflating a balloon to expand stenosis.

 

Other Edits May Impact Your Coding as Well

 

If your neurosurgeon performs vasospasm procedures, you’ll have three new codes for reporting those procedures:

61640--Balloon dilatation of intracranial vasospasm, percutaneous; initial vessel

+61641---each additional vessel in same vascular family (list separately in addition to code for primary procedure)

+61642---each additional vessel in different vascular family (list separately in addition to code for primary procedure).

How it works: The three vascular families are the three main branches that come off of the aorta and feed the brain: innominate, left and right carotid arteries. You should report 61640 when your neurosurgeon performs a balloon dilation in any one of these families.

If the physician does multiple dilations in one family, you should report 61641 for the additional procedures. Use code 61642 when he moves into a second vascular family.

Revised: Effective Jan. 1, 2014, you submit code 64616 (Chemodenervation of muscle[s]; neck muscle[s], excluding muscles of the larynx, unilateral [e.g., for cervical dystonia, spasmodic torticollis]) in place of now deleted code 64613.

Two more additions: With the 2006 CPT^®changes, the American Medical Association also adds two codes for the treatment of hyperhidrosis, or excessive sweating. You can begin reporting 64650 (Chemodenervation of eccrine glands; both axillae) and 64653 (Chemodenervation of eccrine glands; other area[s] [e.g., scalp, face, neck], per day) after Jan. 1, 2006.