Neurosurgery Coding Alert

Question: Our neurosurgeon recently took over the postoperative care of another surgeon's spinal-fusion patient. Should we report E/M codes for these visits, or the surgical code with modifier -52 appended?

New York Subscriber

Answer: If you assume a patient's postoperative care, you should report the code for the surgical procedure and append modifier -55 (Postoperative management only). You should prorate the postoperative component by indicating the days the neurosurgeon was responsible for the postoperative care in the "start date" and "end date" fields of the claim. This requires close coordination with any other physician providing post-op care to avoid double-billing.

The Physician Fee Schedule divides the percentage of relative value units into a procedure's pre-, intra- and postoperative components. Appending modifier -52 (Reduced services) to the surgical procedure tells the carrier that you performed a reduced service (and it doesn't sound as if your surgeon did), so this modifier isn't appropriate in your scenario.

You should report an E/M code (99201-99215 for outpatients, 99221-99233 for inpatients) only if the neurosurgeon treats another problem that's unrelated to the original surgery. In this case, you would append modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the appropriate E/M code.