Neurosurgery Coding Alert

Remember: You should choose a code based on the complexity of the aneurysm, not the surgery

Coders must be careful when choosing between simple and complex aneurysm surgery codes, because code choice depends on what type of aneurysm the neurosurgeon treats. But the line that divides simple and complex aneurysms can be a little blurry at times -- especially on -difficult- procedures that the neurosurgeon performs on simple aneurysms.

So what should you do if the surgeon removes an aneurysm that is by definition simple, but it takes significantly more work and expertise than your basic simple aneurysm fix? Resist the temptation to upcode the claim; instead, rely on modifier 22 (Unusual procedural services) to account for the extra physician work, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, CPC-EMS, RCC, coding analyst for CodeRyte in Bethesda, Md.

Experts recommend you use modifier 22 if a -simple- aneurysm surgery takes more of the surgeon's time and expertise to complete, but you-ll need to follow some documentation rules in order to use it effectively.

There are several reasons why a simple aneurysm may require more work. If the simple aneurysm is in a highly sensitive area, such as adjacent to a nerve, it may require more time and expertise to fix.

In addition, an aneurysm that has been previously treated by intra-vascular occlusion -- or one that is ruptured but is repaired without trapping -- could also qualify as a difficult simple aneurysm.

A patient's medication regimen might also make a simple aneurysm more difficult to repair, according to Teresa Thomas, CPC, practice manager at St. John's Clinic Neurosurgery in Springfield, Mo.

Consider this example, courtesy of Thomas: The patient has a simple vertebrobasilar aneurysm that is 11 mm in diameter. Due to a regimen of blood thinner medication, the patient's aneurysm ruptures.

-This makes the repair more difficult, due to the altered field,- Thomas says. In this scenario, modifier 22 would be a good option to account for the surgeon's extra work. On the claim:

- report 61702 (Surgery of simple intracranial aneurysm, intracranial approach; vertebrobasilar circulation) for the aneurysm surgery.

- append modifier 22 to 61702 to show that the repair took more time and expertise than a normal 61702 service.

Show Your Neurosurgeon's Extra Work With Stellar Documentation

Experts agree that a modifier 22 claim without adequate documentation stands almost no chance of acceptance. -There are some modifiers that will always require the provider to send in documentation. Modifier 22 is one that requires documentation,- Jandroep says.

On the claim for the above example, be sure to include the neurosurgeon's explanation as to why the surgery became more difficult (i.e., the aneurysm rupture). -It is also good practice to dictate the amount of time the encounter took,- Thomas adds.

Good idea: Jandroep recommends that you send in a copy of the op report with the claim, and underline the portions of the report that support the use of modifier 22.  -Don't use highlighter, as it will either not be picked up during scanning or worse -- it will block out what you are trying to highlight,- Jandroep says.

If you cannot find anything in the report to underline, you-re better off not using modifier 22. Without specific documentation justifying modifier 22 use, -it is highly unlikely you will get paid more, and it will just delay your claim,- Jandroep says.