Neurosurgery Coding Alert

Question: During surgery our surgeon dictated that she performed "control of bleeding." How do we code for that procedure?

Arkansas Subscriber

Answer: When the surgeon performs a major procedure, such as spinal fusion (for example, 22554, Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace [other than for decompression]; cervical below C2), control of bleeding is an included component of the surgery.

If the surgeon expended a significant effort to control bleeding during a major procedure, you may attempt to gain additional reimbursement by appending modifier -22 (Unusual procedural service) to the appropriate CPT code. For instance, during repair of ruptured intracranial aneurysm, the surgeon must work extensively to prevent excessive blood loss. In this case, report 61705 (Surgery of aneurysm, vascular malformation or carotid-cavernous fistula; by intracranial and cervical occlusion of carotid artery) with modifier -22 appended. Provide an operative report and cover letter explicitly describing the unusual nature of the surgery and requesting additional compensation.

If the major procedure the surgeon performed was control of bleeding, identify the site and method used and then code accordingly. Some codes that may be appropriate are codes 3520-35286 (related to repair of blood vessel other than for fistula, with or without patch angioplasty), or codes 37565-37700 (related to ligation and other procedures).

-- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandham, CHC, CPC, compliance manager for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno.