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Neurosurgery Coding Alert

Medicare Update:

Retroactive Revisions Could Increase Your Payments

Published on Sun Dec 01, 2002

A recent Medicare policy decision could allow you to collect additional reimbursement for claims already filed. CMS transmittal AB-02-112 (change request 2282), outlining final revisions to the 2002 Medicare Physician Fee Schedule Database, replaced the bilateral surgery indicator "0" (which signifies that no additional payment is appropriate for a bilateral procedure) with a "1" (indicating that a 150 percent payment adjustment applies for bilateral procedures) for the following:

  • 61862 Twist drill, burr hole, craniotomy, or craniectomy for stereotactic implantation of one neurostimulator array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray)
  • 61880 Revision or removal of intracranial neurostimulator electrodes
  • 61885 Incision and subcutaneous placement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array
  • 61888 Revision or removal of cranial neuro-stimulator pulse generator or receiver
  • +63043 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, reexploration, single interspace; each additional cervical interspace (list separately in addition to code for primary procedure)
  • +63044 each additional lumbar interspace (list separately in addition to code for primary procedure)
  • 64821 Sympathectomy; radial artery
  • 64822 ulnar artery
  • 64823 superficial palmar arch
  • 0005T Transcatheter placement of extracranial cerebrovascular artery stent(s), percutaneous; initial vessel
  • +0006T each additional vessel (list separately in addition to code for primary procedure)
  • 0007T Transcatheter placement of extracranial cerebrovascular artery stent(s), percutaneous, radiological supervision and interpretation, each vessel.

    Previously, Medicare provided no additional reimbursement for the above, even if coders appended modifier -50 (Bilateral procedure) or modifiers -LT (Left side) and/or -RT (Right side) to indicate a bilateral procedure. You may now receive a 150 percent payment adjustment for such procedures if documentation supports the claim and you append the correct modifier(s).

    The fee schedule revisions are retroactive to Jan. 1, 2002, but Medicare has instructed carriers that they "need not search their files to either retract payment for claims already paid or to retroactively pay claims." Therefore, to receive adjusted compensation for previously paid claims, you must refile and specifically request additional payment. Based on national averages, this could mean the difference between $1,284 (61862 performed bilaterally but paid unilaterally) and $1,926 (61862 performed and paid as a bilateral procedure), for instance.

    Note: To view transmittal AB-02-122, visit the CMS Web site: www.cms.gov/manuals/pm_trans/ab02112.pdf.

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