Neurosurgery Coding Alert

Nugget: Coding complex spine surgeries using the following five tips will assist in properly billing Medicare and third-party insurance companies for optimum payment.

Claims for spine surgery can be highly complex, and many coding and procedural practices can cause reductions, denials, or delays by insurance carriers. The following suggestions may help to increase pay ups for spine surgery claims.

1. Billing for bone graft. A common spinal coding error is not billing for the bone graft when a neurosurgeon performs an arthrodesis (for example, 22612, arthrodesis, posterior or posterolateral technique, single level; lumbar [with or without lateral transverse technique]) or inserts instrumentation (for example, 22842, posterior segmental instrumentation [e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires]; 3 to 6 vertebral segments), says Ginger Adkins, CPC, account manager for five neurosurgeons at the Neurosurgical Medical Clinic in San Diego. Adkins says that codes 20930 (allograft for spine surgery only; morselized) or 20931 (allograft for spine surgery only; structural) are usually appropriate with an allograft (bone that comes from a bone bank). And codes 20936 (autograft for spine surgery only [includes harvesting the graft]; local [e.g., ribs, spinous process, or laminar fragments] obtained from same incision), 20937 (autograft for spine surgery only [includes harvesting the graft]; morselized [through separate skin or fascial incision), or 20938 (autograft for spine surgery only [includes harvesting the graft]; structural, bicortical or tricortical [through separate skin or fascial incision]) often are used for an autograft (bone that comes from the patient’s own body). Coders should know whether the bone graft was morselized or structural.

2. Billing 22630 and diskectomy or laminectomy at the same level. Reporting of 22630 (arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace [other than for decompression], single interspace; lumbar) and a diskectomy (63030) or laminectomy (63047) at the same level can lead to denials according to Linda Bell, assistant office manager for George Sypert, MD, one of the creators of the CPT codes for neurosurgery, in Ft. Myers, Fla. Bell says that according to CPT 2000, code 22630 includes a diskectomy and/or laminectomy at the same level and therefore these codes should not be billed separately. If a “redo” surgery is being performed— surgery that has to be redone for any number of reasons including rejection, complications, instability, or reinjury — code 63042 (laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, reexploration; lumbar) should be used and not bundled into 22630, which may be billed separately.

3. Code the correct number of levels. Coders who are new to neurosurgery sometimes get confused when reading operative reports for diskectomies and bill for an incorrect number of levels. Adkins suggests that the coder should keep in mind that 3-4 is one level and 4-5 is another level. A single level includes the space between two vertebrae, not one.

4. Check for coverage. A neurosurgeon or coder should investigate whether a patient’s insurance coverage is in effect and if the planned procedure will be covered before surgery, Adkins urges. If surgery is
not going to occur for a few weeks or months, the neurosurgeon should know as much as possible about the patient’s insurance status. A preauthorization letter to the patient’s insurance carrier should be used to ascertain not only eligibility but also full benefit information, including whether the services of surgical assistants will be covered. Bell suggests that a copy of the preauthorization letter should be sent to the patient so he or she knows what percentage of the overall claim the insurance company will cover and what he or she will be expected to pay out of pocket.

5. Collect co-pays. When dealing with managedcare patients, neurosurgeons need to collect the co-pays from the patient swiftly to demonstrate to the managedcare carrier that this aspect of the contract is being followed, Bell advises. Managed-care companies monitor the collection of co-pays by physicians, and payment for services from managed-care payers may be delayed if co-pays are not collected as per the contracted conditions.