Neurosurgery Coding Alert

The “Introduction” to the Correct Coding Initiative (CCI) manual defines the criteria by which it assigns code pairs to the comprehensive/component category. Here are some select principles.

CPT Definition. Some CPT codes are part of a series in which the first code becomes a component for the following codes. For example, 61512 (craniectomy, trephination, bone flap craniotomy; for excision of memingioma, supratentorial), if performed through the same craniectomy as a tumor removal (61510), would be considered part of that procedure.

CPT Manual Instructions/Guidelines. CPT also gives bundling instructions in the code descriptors or at the beginning of some sections in the manual (e.g., see code 22554).

Separate Procedures. A separate procedure is generally a minor procedure, which, if performed at the same time as a larger procedure, is bundled. These “separate procedures” form the basis of many black-box coding edits, additional disallowed code pairs added to the CCI guidelines. For example, 61050* (cisternal or lateral cervical [C1-C2] puncture; without injection [separate procedure]) would be included in a brain tumor excision, even though it is not listed in the CCI as a component of a brain tumor excision. Code 61050 is payable only if it is performed as a separate procedure.

More Extensive Procedures. During a single operative session, the more extensive procedure subsumes prior lesser components. For example, if a cerebral hematoma is discovered while removing a subdural hematoma, the prior would subsume the latter and be billed as the cerebral hematoma.

With vs. Without Procedures. This principal defines whether a specified component is included in a given range. For example, 63047 (laminectomy, facetectomy and foraminotomy [unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (e.g., spinal or lateral recess stenosis)], single vertebral segment; lumbar) can be done with or without facetectomy — so a separate charge for facetectomy would not be allowed.

Standards of Medical/Surgical Practice. This category identifies unspecified code pairs that are listed under the comprehensive code category and may be disallowed based on known and accepted surgical standards, and those circumstances in which they may be billed separately. For example, because stereotactic procedures always include the placement of the head frame, the component head frame would not be coded separately. It is presumed that the payment amount that has been developed for the comprehensive stereotactic procedure reflects the component frame placement, although there is actually no evidence to support this presumption.