Neurosurgery Coding Alert

Hint: Code G9531 will see some revisions in 2020.

The Centers for Medicare & Medicaid Services (CMS) recently published the 2020 HCPCS Level II code changes. These updates will become effective on Jan. 1, 2020.

Read on to learn more about how the new revisions, additions, deletions, and the new modifiers will impact your neurosurgery practice during the coming year.

Focus On These Shiny New Codes

Take a look at the following new 2020 HCPCS Level II codes you can expect to see in 2020 for neurosurgery:

• C9757 (Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and excision of herniated intervertebral disc, and repair of annular defect with implantation of bone anchored annular closure device, including annular defect measurement, alignment and sizing assessment, and image guidance; 1 interspace, lumbar)
• G2151 (Patients with diagnosis of a degenerative neurological condition such as als, ms, parkinson’s diagnosed at any time before or during the episode of care)
• K1002 (Cranial electrotherapy stimulation (ces) system, includes all supplies and accessories, any type)

“Keep in mind that the creation of a level II HCPCS code does not inform you regarding whether a commercial carrier will cover the specified service,” says Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey. “For example, C9757 describes a combination of the service included in 63030 for unilateral lumbar discectomy but adds the service of annular repair with a closure device. The latter service may be considered experimental, investigational and/or unproven and therefore not a covered service.”

Don’t miss: If you look through the HCPCS Level II code set for 2020, you will see 41 new codes with duplicate descriptors and 12 revised codes with duplicate descriptors. The new codes for a degenerative neurological condition that the neurosurgeon diagnoses any time before or during the episode of care fall in this category.

Currently, HCPCS Level II lists the following seven new codes with the exact same code descriptor. Hopefully this mistake will be clarified soon, but for now, here are the codes as they currently appear in the HCPCS Level II new codes list:

• M1107 (Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson’s diagnosed at any time before or during the episode of care)
• M1112 (…)
• M1117 (…)
• M1122 (…)
• M1127 (…)
• M1131 (…)
• M1136 (…)

Dial Into 3 Important Revisions

Make sure you know which HCPCS Level II revisions to look for in 2020.

Revision 1: For example, G9531 (Patient has documentation of ventricular shunt, brain tumor, multisystem trauma, pregnancy, or is currently taking an antiplatelet medication including: abciximab, anagrelide, cangrelor, cilostazol, clopidogrel, dipyridamole, eptifibatide, prasugrel, ticlopidine, ticagrelor, tirofiban, or vorapaxar) will see a couple of revisions. Emphasis added.

As you can see, pregnancy is no longer included under the documented conditions in the code descriptor. Also, this revision will add “anagrelide” and “dipyridamole” to the code descriptor, which describe antiplatelet medications a patient might be currently taking.

Revision 2: Documentation code G9595 (Patient has documentation of ventricular shunt, brain tumor, or coagulopathy, including thrombocytopenia) will also see a minor revision. Emphasis added.

As you can see, the revised descriptor for G9595 will delete the words “including thrombocytopenia.”

Revision 3: Code G8674 (Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment not measured because the patient did not complete the general orthopedic fs prom at initial evaluation fs status survey on admission and/or follow up fs status survey and/or near discharge, reason not given) will also see some revisions.

As you can see, the type of fs was changed to “general orthopedic fs prom,” and the descriptor now clarifies that it will be given at the patient’s initial evaluation.

Don’t Miss 2 Deletions

You will also lose two HCPCS Level II codes in 2020. They are as follows:

• G0515 (Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes)
• G8673 (Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate)

Observe New Modifier Options and 1 Deletion

You’ll see eight new HCPCS Level II modifiers in 2020. They are as follows:

• MA (Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical condition)
• MB (Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet access)
• MC (Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues)
• MD (Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of extreme and uncontrollable circumstances)
• ME (The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional)
• MF (The order for this service does not adhere to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional)
• MG (The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional)
• MH (Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider)

Deletion: You will lose modifier GD (Units of service exceeds medically unlikely edit value and represents reasonable and necessary services) in 2020.