Neurosurgery Coding Alert

The procedures for trigeminal neuralgia are performed under sedation, usually by an anesthesiologist. The following are the codes applicable for sedation:

• 99149 (Moderate sedation services [other than those services described by codes 00100-01999], provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; age 5 years or older, first 30 minutes intra-service time)

• +99150 (Moderate sedation services [other than those services described by codes 00100-01999], provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; each additional 15 minutes intra-service time [List separately in addition to code for primary service]).

Note that you cannot report these with 61790 and 61791. "If the surgeon is doing both the procedure and the sedation, then you will need to check the CCI edits. The sedation codes are bundled with 61790 and 61791," says Jennifer Schmutz, CPC, health information coder at the Neurosurgical Associates, LLC in Salt Lake City, Utah.

If the pain recurs and the patient is returned to the operating room within the global period (90 days), you append modifier -78 to 61790 or 61791(Unplanned return to the operating/procedure room by the same physician or other qualified health care professional  following initial procedure for a related procedure during the postoperative period:..........).

Use of Add-on Code

Don't rely on code 61795 (stereotactic computerassisted volumetric [navigational] procedure, intracranial, extracranial, or spinal) to specify the use of computer assistance to map and locate the nerve and lesion site. "Code 61795 was deleted in January this year," says Schmutz. You instead have a choice in codes 61781 (Stereotactic computer-assisted [navigational] procedure; cranial, intradural [List separately in addition to code for primary procedure]) or 61782 (Stereotactic computer-assisted [navigational] procedure; cranial, extradural [List separately in addition to code for primary procedure]).

Tip: You do not report the stereotactic codes with 61790 or 61791. "CPT® code 61790 and 61791 are stereotactic guided, and you would not bill a Stereotactic Radiosurgery CPT® code with these codes," says Thomas.