Neurosurgery Coding Alert

Answer to -separate vs. inherent- question is key to successful claims If the neurosurgeon performs an E/M service and a procedure with a global period of up to 10 days on the same patient during the same encounter, you may be able to report the E/M separately using modifier 25.
 
But before using the modifier, you must prove that the E/M is a separate service and is not an inherent component of the procedure. Follow this advice to find out when to report an E/M with modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) and when to leave the E/M code off the claim. Find Evidence of Separate E/M in Notes

In a nutshell: -Coders should use modifier 25 when a significant, separately identifiable E/M service is performed by the same physician at the same face-to-face encounter as a procedure or other service,- says Catherine Brink, CMM, CPC, president of Healthcare Resource Management of Spring Lake, N.J.
 
The most vital element on successful modifier 25 claims is concrete evidence that the procedure and E/M were truly separate, Brink says. All procedure codes have an inherent E/M component built into them, and the physician must go beyond that to justify a separate E/M. If the decision to perform the procedure results from the medical decision-making performed during the E/M service, you can separately report the E/M with modifier 25. In addition, the E/M service must also meet medical- necessity criteria and be totally separate from the
other procedure.   
 
For example: A patient reports to the neurosurgeon for two sacral joint injections. The surgeon briefly examines the injection area and performs the injections. Notes indicate a limited exam.
 
In this case, insurers aren't likely to accept a code for a significant, separately identifiable E/M service because the surgeon limited the exam to the treatment area.
 
So on this claim, you should report these codes:

 - 64475 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, single level) for the initial injection

 - +64476 (- lumbar or sacral, each additional level [list separately in addition to code for primary procedure]) for the second injection.
 
Try this one: Now check out this scenario, in which the neurosurgeon performs a procedure and a separate E/M service:
 
A new patient presents to the neurosurgeon complaining of neck pain, photophobia and a severe -10 out of 10- headache that has been present for more than a day. The neurosurgeon performs a level-four E/M service to address the symptoms. Fearing the possibility of subarachnoid bleeding, the neurosurgeon decides to perform a spinal tap based on her findings.
 
In this instance, the neurosurgeon provided two separately reportable services: the E/M [...]