Neurosurgery Coding Alert

Question: Our neurosurgeon is looking into new procedures to add to his practice. He wants the billing department to research the cost effectiveness of these new procedures. How do I go about this research?

Anonymous New York Subscriber

Answer: The company endorsing a new procedure or selling the required equipment can provide a great deal of information. Included in their literature will be CPT, ICD-9 and Health Care Financing Administration (HCFA) codes you might bill with this new procedure and equipment, as well as relative value unit (RVU) levels of compensation. Keep in mind, however, that this literature is designed to sell practitioners on the virtues of the product, therefore, acquiring this literature should be only the first step in the research process.

Rhonda Petruziello, CPC, a neurosurgery reimbursement specialist who works with the Cleveland Clinic Foundation in Cleveland, says, When we become interested in a new type of technology or procedure, we thoroughly research what the vendor provides. This research includes comparing the description of the procedure to articles in peer-reviewed publications and all coding and reimbursement information to CPT 2000, the Correct Coding Initiative, and Relative Base-Relative Value Study (RB-RVS) and carrier and managed care provided fee schedules. Manufacturers often will unbundle codes to give the appearance of a higher potential reimbursement for procedures and the use of new equipment.

I also get input from the physician and network with other facilities and providers, Petruziello says. She also urges billers to research a potential procedure and the attendant equipment from a liability standpoint by questioning insurance companies and local American Association of Neurosurgeons representatives.