Neurosurgery Coding Alert

Watch out for 0077T and twist drill hole bundling, too

You haven't been able to report the placement of stereotactic frame with stereotactic radiosurgery because the National Correct Coding Initiative bundles the codes. With version 12.1, NCCI is telling you that now you can't report 20660 with other stereotactic surgery codes (61720-61791), either.

Avoid the Modifier 59 Temptation

CPT has previously offered guidelines stating that you should not separately report the application of a frame when the neurosurgeon performs the procedure as a component of a larger procedure. CMS is now adding this guidance to their NCCI edits, says Annette Grady, CPC, CPC-H, healthcare consultant in Bismarck, N.D., and member of the AAPC National Advisory Board.

NCCI 12.1 bundles 20660 (Application of cranial tongs, caliper, or stereotactic frame, including removal [separate procedure]) with stereotactic radiosurgery code 61793 (Stereotactic radiosurgery [particle beam, gamma ray or linear accelerator], one or more sessions).

Beware: You cannot override this edit with modifier 59 (Distinct procedural service) because the bundle has a -0- indicator. A neurosurgeon would not perform this procedure except in conjunction with the stereotactic procedure, says Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery in New York.

Other NCCI 12.1 bundling edits you should take note of include:

- Burr holes and twist drill holes (61140, 61150, 61151, 61154, 61156, and 61210) with the category III code for placement of cerebral thermal perfusion probe (0077T, Implanting and securing cerebral thermal perfusion probe, including twist drill or burr hole, to measure absolute cerebral tissue perfusion).

This edit makes sense since 0077T specifically includes burr and twist drill holes in its code definition, Sandhusen says.

- Wound care code 97602 (Removal of devitalized tissue from wound[s], nonselective debridement, without anesthesia [e.g., wet-to-moist dressings, enzymatic, abrasion], including topical application[s], wound assessment, and instruction[s] for ongoing care, per session) and negative pressure (VAC) dressing codes 97605 (Negative pressure wound therapy [e.g., vacuum-assisted drainage collection], including topical application[s], wound assessment, and instruction[s] for ongoing care, per session; total wound[s] surface area less than or equal to 50 square centimeters) and 97606 (... total wound[s] surface area greater than 50 square centimeters) into the new codes for incision and drainage of deep spinal abscesses (22010-22015).

NCCI also bundles them with all closed or open vertebral fracture repair codes (22305-22327) and neuroplasty codes (64702-64726), including carpal tunnel release and ulnar decompression. -Wound care codes are generally performed by physical therapy or qualified nursing staff, and really should not reflect significantly on the physician's practice,- Grady says.

- Harvest of tissue graft (20926, Tissue grafts, other [e.g., paratenon, fat, dermis]) into the laminoplasty codes (63050 and 63051).

- Laminoplasty code 63050 into laminoplasty code 63051. Even before this NCCI edit, you would only bill 63050 with 63051 if the neurosurgeon did an open-door laminoplasty at two levels and then did an open-door laminoplasty with reconstruction of posterior elements at two different levels. You would have applied modifier 51 (Multiple procedures) to 63051. Now you-d report this rare procedure using modifier 59 to override the edits instead of modifier 51, Sandhusen says.