Neurosurgery Coding Alert

CMS admits mistakes in fee schedule, but you'll have to do the legwork

With a little research and some paperwork, you may realize additional reimbursement for spine surgery procedures your neurosurgeon performed earlier this year. CMS fixed some glitches in the 2006 physician fee schedule in Transmittal 889 (Change Request 4399) and, to your benefit, most of them are retroactive to January.

Revisit Your Multiple-Laminectomy Add-on Claims

To ensure your neurosurgery practice isn't losing out, you-ll want to take note of two corrections CMS published. In the transmittal, CMS revises these indicators:

- Bilateral-surgery indicators for laminectomy add-on codes 63035, 63043 and 63044 and spinal anesthetic injection codes 64480 and 64484 change from -0- to -1.- They were set at -0- by mistake.

- Multiple-procedures indicators for spinal graft codes 20931, 20937 and 20938 change from -2- to -0.- Again, CMS is correcting a mistake.

The change to the bilateral-surgery indicators for spinal surgery codes is -a great relief,- says Rena Hall, coder with Kansas City Neurosurgery in Missouri.

Carriers have been denying bilateral multiple claims for laminectomy add-on claims since January, and -unless you watch your denials closely, this is a lot of money,- says Marcella Bucknam, coding manager for the University of Washington's physician group in Seattle. Missing a denial in which you only received payment for one unit instead of two is easy, especially with all the other codes you-d be billing at the same time.

Important: You won't get the money you-re owed for these spinal surgery claims since January unless you resubmit them. Using a computer system that lets you easily research these claims is a good idea, Hall says.

Example: Medical College of Wisconsin in Milwaukee will have 10 claims for laminectomy add-on codes and as many as 124 spinal graft code claims to research, according to Medical College of Wisconsin coder Sharon Hathaway.