Neurosurgery Coding Alert

Fewer E/M billing opportunities are offset by instrumentation revisions

Beginning Oct. 1, you'll no longer be able to report fluoroscopic or ultrasound guidance for needle placement (76003 and 76942, respectively) during shunt puncture (61070, Puncture of shunt tubing or reservoir for aspiration or injection procedure) or diskography procedures 62290 (Injection procedure for diskography, each level; lumbar) and 62291 (... cervical or thoracic).

The latest round (version 10.3) of National Correct Coding Initiative (NCCI) edits now bundles 76003 and 76942 to 61070 and 62290/62291, thereby making the imaging for needle guidance an integral (and un-reimbursable) part of the injection procedures.

Look for Neurostim Analysis/Implantation Bundles

Surgeons placing or revising spinal neurostimulator pulse generators (63685, Incision and subcutaneous placement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling and 63688, Revision or removal of implanted spinal neurostimulator pulse generator or receiver) may no longer bill separately for analysis and reprogramming of complex pulse generator (95974, Electronic analysis of implanted neurostimulator pulse generator system [e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements]; complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour).

Include analysis in placement: You should treat the initial programming of the neurostimulator as included in the surgical placement/replacement and not charge separately for the service.

Past editions of NCCI already bundled analysis/programming of simple neurostimulators (such as 95971) to implantation codes.

Deletions Allow Instrumentation With Spinal Surg

On the upside, you can now report additional spinal instrumentation procedures with spinal fracture treatments and arthrodesis.

Specifically, NCCI has deleted edits for 22849 (Reinsertion of spinal fixation device), 22850 (Removal of posterior nonsegmental instrumentation [e.g., Harrington rod]), 22852 (Removal of posterior segmental instrumentation) and 22855 (Removal of anterior instrumentation) that bundled the procedures to vertebral fracture repairs 22318-22327 and arthrodesis codes 22548-22558, 22630 and 22800-22812.

Therefore, for instance, if the surgeon performs arthrodesis (for example, 22630, Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace [other than for decompression], single interspace; lumbar) and removes previously placed posterior segmental instrumentation (22852), you may report both 22630 and 22852.

"The deletion that will help us the most is the one that bundled 22849 (Reinsertion of spinal fixation device) with the other codes," says Christine Hauer, coding supervisor at a surgical practice in Kansas City. "We've had problems in the past when the surgeon had to replace pins during surgery, and the insurers would deny the pin replacement and say it was included."

No More Same-Day Consult and Hospital Admit

You can no longer bill for a consult if the physician also placed the patient under observation or admitted him as an inpatient.

NCCI 10.3 now makes initial and follow-up inpatient consultations (99251-99263) components of observation or inpatient hospital care codes 99234-99236. There are no circumstances under which you may override the edits using a modifier.

NCCI version 10.3 covers the final quarter of 2004, beginning Oct. 1 and ending Dec. 31.