Neurosurgery Coding Alert

Experts recommend that you ask payers for modifier policy specifics
 
When your neurosurgeon performs multiple surgical procedures on the same patient, coders have to decide if a modifier is appropriate for the claim. Often you will be deciding between modifiers 59 (Distinct procedural service) and 51 (Multiple procedures).

If you do not choose the proper modifier, you could be getting a denial in the mail for the encounter. Follow this expert advice for deciding between modifiers 59 and 51 for your neurosurgeon's encounters.
 
If Unbundling NCCI, Use Modifier 59
 
In general, you-ll use modifier 59 -to identify procedures/services that are not normally reported together, but are appropriate under certain circumstances,- says Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc. in Lansdale, Pa. You can use modifier 59 to represent:

- a different session or patient encounter

-  a different procedure or surgery

-  a different site or organ system

-  a separate incision/excision

-  a separate lesion

-  a separate injury not ordinarily encountered or performed on the same day by the same physician.
 
Consider this example, courtesy of Jennifer Avery, CCS, CPC-H, president-elect of the AAPC's Oklahoma City chapter and lead coder at Oklahoma's HPI LLC:

The neurosurgeon performs a fusion with laminectomy for the decompression of spinal (lateral recess) stenosis. -The physician is not removing the bare minimum of the disc for the fusion, but rather to treat the stenotic condition and decompress the nerve roots. Therefore, you should get paid for both procedures,- Avery says.

On the claim, you should: 

- report 22630 (Arthrodesis, posterior interbody prepare interspace [other than for decompression], single interspace; lumbar) for the fusion.

- report 63047 (Laminectomy, facetectomy and foraminotomy [unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s) (e.g., spinal or lateral recess stenosis)], single vertebral segment; lumbar) for the laminectomy.

- append modifier 59 to 63047 to show that the procedures were separate. 

Don't forget documentation: On your modifier 59 claims, -the surgeon should clearly document the separate anatomical areas if applicable, or clearly document that this particular portion of the surgery is unrelated to the other component of the surgery,- Falbo says.

You-ll also use modifier 59 to unbundle certain codes from the National Correct Coding Initiative edits. If NCCI assigns the code bundle an indicator of -1,- you can undo the bundle in certain situations, says Falbo. If the bundle has an indicator of -0,- you can never unbundle it for any reason.

When coding, remember to attach modifier 59 to the secondary (or -component-) code on your claim, and report the primary code without a modifier. In NCCI, the primary code is listed in Column 1 of the edits, while component codes appear in Column 2.
 
Expect Pay Reduction When Using 51
 
Coders should look to modifier 51 when the neurosurgeon performs [...]