Neurosurgery Coding Alert

Question: Our neurosurgeon performs craniofacial surgeries with a plastic surgeon. The plastic surgeon's office bills 21175. Our office uses 61557-62. The plastic surgeon says that he has no involvement in the craniotomy. Should we bill according to standard co-surgery rules or can we bill separately?

New York Subscriber

Answer: The Medicare Carriers Manual states that when surgeons of different specialties perform distinct, sequential procedures like this, each should bill his portion separately, at full fee, with no modifier. So, the correct coding for your office would be 61557 (craniotomy for craniosynostosis; bifrontal bone flap) for the craniotomy without modifier -62 (two surgeons), and the plastic surgeon should bill 21175 (reconstruction, bifrontal, superior-lateral orbital rims and lower forehead, advancement or alteration, with or without grafts [includes obtaining autografts] for the reconstruction.

Answers provided by Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno; Michael W. Potter, MD, president of Cascade Neurosurgery and Spine Inc., and a practicing neuro-surgeon for 19 years in Medford, Ore.; and Karen Evans, RN, CPC, a coding and reimbursement specialist in Mount Vernon, Wash.