Neurosurgery Coding Alert

Be vigilant for series of events in the postoperative period

You will need to read the operative note in depth to learn if the neurosurgeon does any evaluation after the surgical procedure. For a postoperative visit that is related to the original procedure, you would code 99024 (Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure). "Usually a provider can only charge for E&M services in a global period that are not related to the condition for which the surgery was performed. You report the E&M code with a modifier -24," advises Gwendolyn M. Flaherty, CPC, NeuroScience Associates, Idaho. You append modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period.....) for an evaluation done in the postoperative period. For evaluation after a procedure, you report 99024 for a postoperative visit, unless it is a new problem in which case you would charge the E&M and modify it with a -24, says Marilyn Glidden, CPC, NeuroScience and Spine Associates, Naples, Florida. However, you should make sure that the documentation indicates that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure.

Most evaluation and management services are included in the global period, but be vigilant for the exceptions. You append modifier -57 (Decision for surgery:....) if the neurosurgeon performs an evaluation and the results of the same guide the need for surgery that day or the following day. "In such cases, you would use modifier -57 which indicates that a particular evaluation and management service was when the decision for surgery was determined. If a surgical procedure is performed in the global period of another unrelated procedure, modifier -24, which states that an unrelated evaluation and management service was provided during the postop period, would be appended to the subsequent unrelated procedure. "Again the diagnosis must be unrelated to the procedure for which the patient is in the postop period," says Michelle L. Benz, business manager, Neurosurgery and Spine, SC, Milwaukee.

Example: Have a look at this operative note scenario: 'After a pedicle subtraction osteotomy and long spinal fusion from T3 to the sacrum for scoliosis and junctional kyphosis, the patient developed quadriparesis with a neurologic deficit that was at a level distant from the site at which the spinal canal was opened. Cervical spondylosis compressing the lower cervical segment of the spinal cord was diagnosed on the computed tomography myelogram. The patient was taken to the operating room as an emergency and laminectomy with decompression of the cervical spinal cord was done.' In this instance, you would report an appropriate evaluation and management code and append modifier -24 for the evaluation and management service unrelated to the prior thoracolumbosacral surgery. "The emergency myelogram would be described with code 62284 (Injection procedure for myelography and/or computed tomography, spinal (other than C1-C2 and posterior fossa) and code 72240 (Myelography, cervical, radiological supervision and interpretation) -26 (Professional Component:...) as well as code 63001 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; cervical). These procedures would be appended with modifier -79 for the return to the operating room for an unrelated procedure," advises Dr. Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.