Neurosurgery Coding Alert

Hint:  Identify the reason for the neuroendoscopy.

The key to correctly coding neuroendoscopies is to determine what structure your surgeon is excising.  Follow this advice for successfully navigating these services.

When your surgeon uses a neuroendoscope to dissect adhesions, you report code 62161 (Neuroendoscopy, intracranial; with dissection of adhesions, fenestration of septum pellucidum or intraventricular cysts [including placement, replacement or removal of ventricular catheter]).

Note: Do not code for the access separately. The national Correct Coding Initiative (CCI) bundles ‘access’ procedures, such as burr hole and twist drill procedures, to the endoscopy. Codes for ‘twist drill, burr hole(s), or trephine’ (61105-61253) are included in the intracranial neuroendoscopy codes. “The neuroendoscopy codes include the burr hole necessary to gain access to the intracranial cavity,” says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison. So this means you should not separately report twist drill, cranial burr or trephine services when the surgeon uses any of these devices to allow for the neuroendoscope’s entry into the skull.

Combat the Coding Challenge in Ventricular Cyst Fenestration

You may read that your surgeon used a ventriculoscope to fenestrate a tumor cyst in the third ventricle and also places a ventriculoperitoneal shunt. Note the challenge here is coding for the shunt and the cyst fenestration, both of which include ventricular catheter placement.

For the cyst fenestration, you report code 62161. For the VP shunt, you report code 62223 (Creation of shunt; ventriculo-peritoneal, -pleural, other terminus). Append modifier 52 (Reduced services) with code 62223 for the overlap of services. “While the neuroendoscopy codes include the placement of a ventricular catheter, they do not include placement of a venticuloperitoneal shunt.  Consequently, placement of a shunt, which includes placing the ventricular catheter, should be reported with the reduced services modifier,” says Przybylski.

When your surgeon does neuroendoscopy to remove a foreign body, you report 62163 (Neuroendoscopy, intracranial; with retrieval of foreign body). You report 62164 (Neuroendoscopy, intracranial; with excision of brain tumor, including placement of external ventricular catheter for drainage) for brain tumor excision. Excision of pituitary tumor has a distinct code. You turn to 62165 (Neuroendoscopy, intracranial; with excision of pituitary tumor, transnasal or trans-sphenoidal approach) for pituitary tumor excision.

Report 62160 as Add-On Code

The only add-on neuroendoscopy code is +62160 (Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage [List separately in addition to code for primary procedure]). This code describes the additional work of neuroendoscopic assistance. You report code 62160 with other codes, i.e. 61107, 61210, 62220, 62223, 62225 and 62230.

The other codes for neuroendoscopy, 62161-62165 (Neuroendoscopy, intracranial; with excision of pituitary tumor, transnasal or trans-sphenoidal approach) are not add-on codes. These are ‘primary’ procedure codes that substitute the open code when your surgeon performs the procedure endoscopically.

Exercise Caution in Reporting Open Procedure Code with Endoscopy

You cannot report endoscopy codes with those for the open procedure. You should never take endoscopy to be an additional step beyond the open procedure. “The neuroendoscopy procedure codes were designed as stand-alone codes for procedures performed only with a neuroendscope,” says Przybylski.  If an open technique is assisted with an endoscope, you should report the open procedure. You may consider appending the 22 (Increased procedural services) modifier if there is significant additional work.

Example: When your surgeon does an endoscopic fenestration of a supratentorial cyst, you report code 62162 (Neuroendoscopy, intracranial; with fenestration or excision of colloid cyst, including placement of external ventricular catheter for drainage). Do not report the open procedure code 61516 (Craniectomy, trephination, bone flap craniotomy; for excision or fenestration of cyst, supratentorial) with 62162.