Neurosurgery Coding Alert

Neurosurgeons often treat patients who are filing or intend to file workers compensation claims for injuries suffered on the job. But getting paid for these services often is challenging. By monitoring payment amounts and researching carriers, neurosurgeons can ensure they are properly reimbursed by workers comp plans.

Anita Daye Foster, MA, CPC, CCS-P, senior vice president of Coding and Operations for The Coding Network in Hawthorne, Calif., an independent coding consultant to a variety of organizations and academic facilities including USC, UCLA, Stanford, and Yale, cautions that some workers comp carriers do not always follow their own rules or pay at appropriate rates according to their own manuals.

If you use microscopic dissection (69990), an adjunct code specific to certain procedure codes, many workers comp carriers will reduce it by 50 percent, and if you do laminectomies (63045) at multiple levels (63048), they will reduce the multiple level code, Foster says. But this is inappropriate. Adjunct codes carry a unit value that takes into consideration that they do not warrant a modifier -51 (multiple procedures). They are already reduced. Such improper practices by workers comp carriers must be monitored and challenged by appeal.

Foster suggests that if neurosurgeons deal with a high volume of workers comp cases, they should upgrade their billing software by programming in the relative value units (RVU) as established by the workers comp carriers in their states. Many offices have coders sending out bills and claims processors receiving payments. By upgrading the software to calculate the appropriate amount that should be paid at the beginning of the billing process, any inappropriate reductions can be caught easily. Staff productivity also will be improved because claims processors will not have to manually look up and calculate the amount that should have been paid on each claim. That information will be apparent immediately with a quick comparison of what should have been paid with the amount received.

Research Which Codes Carriers Are Accepting

Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno, says that Medicare always uses the most up-to-date codes, but workers comp carriers are not required to do so. Some workers comp carriers in New Jersey use CPT 1994, for example, while others in Florida use CPT 1996, and still others in California use CPT 1999.

Foster says getting current codes paid by certain workers comp carriers can be difficult. And when they are paid, it may not be at the appropriate amount because there are no set RVUs for these codes in that particular workers comp fee schedule. Copies of the appropriate pages from [...]