Neurosurgery Coding Alert

New edition targets surgical codes With more than 9,000 changes in the latest National Correct Coding Initiative (NCCI) quarterly update (version 13.0, effective Jan.1), you could spend an entire month trying to determine how the edits will affect your neurosurgery practice.

Or you could simply look below for the most important additions and deletions. NCCI Affects New Spine Codes The new edition of NCCI bundles 69 codes into the new percutaneous intradiscal electrothermal annuloplasty codes 22526 (Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level) and +22527 (- one or more additional levels [list separately in addition to code for primary procedure]).

For instance, you can no longer bill spinal surgery 62270, 62287, 62290-62291, 62310-62319 and discography 72285 and 72295 with new codes 22526-22527.

But hopefully this shouldn't affect many practices because you may have expected these bundles. -The discography codes seem to be an integral part of the annuloplasty procedure, so this doesn't surprise me,- says Denise Paige, CPC, president-elect of the AAPC's Long Beach Chapter.

Arthroplasty targeted: The NCCI also created more than 40 new component codes that will now be bundled into the new total disc arthroplasty codes 22857-22865.

Among the procedures that are now bundled into these codes are other arthrodesis codes, spinal instrumentation codes, laparotomy codes, needle electromyography codes, nerve conduction studies codes, an intraoperative neurophysiology code (95920), and evoked potentials and reflex test codes (95925-95937).

-This isn't a big surprise, either,- Paige says. -It seems, despite what the vendors say, that most of the intraoperative imaging and sensory tests seem to be bundled and not separately payable.-

As far as the instrumentation being included in the total disc arthroplasty, -it also seems to be the trend to lump everything into one code (the laminoplasty codes are one example), which makes it easier to code, but payment-wise it may not be so beneficial,- Paige says. -But then when you look at the multiple procedure/payment rules that most carriers have, it may end up the same whether it's one code or several.- Prepare for -Medically Unlikely- Edits Coders have heard rumors for several years about -medically unbelievable- or -medically unlikely- edits, but this time, CMS has gone ahead and instituted the new medically unlikely edits.

Effective for dates of service on or after Jan. 1, 2007, you-ll have to contend with the MUEs, which are separate from the already-established NCCI edits -- but if the edits function as intended, you should find them more a help than a hindrance to your practice.

Bone Up on the New MUEs The goal: The new edits are designed to prevent overpayments caused by gross billing errors, usually as the result of clerical or billing system mistakes, said Niles Rosen, medical director [...]