Neurosurgery Coding Alert

Question: A neurosurgeon saw a patient in the hospital and decided surgery was needed (99252-57). The patient was discharged for the weekend. Three days later, the neurosurgeon admitted him and performed surgery that day. Can we charge for the admit with the surgery?

Louisiana Subscriber

Answer: First, there is no need to append modifier -57 (decision for surgery) to the 99252 (initial inpatient consultation), because more than 24 hours elapsed between the initial consultation and the readmit for surgery. Second, the later admission is now an elective one, specifically for the surgery, and becomes included in the surgical global services and should not be separately billed.


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, a coder who specializes in neurosurgical procedures; and Michael W. Potter, MD, president of Cascade Neurosurgery and Spine Inc., and a practicing neurosurgeon for 19 years in Medford, Ore.