Neurosurgery Coding Alert

Question: Our surgeon performs his own myelograms, usually the day before surgery. He dictates the results and discusses them with the patient before deciding on surgery. We bill the myelogram using 62284 with the observation code 99220. Often, 62284 is denied as included in 99220. In other cases, 62284 is reimbursed at a reduced rate. Is this correct?

Pennsylvania Subscriber  
Answer: Code 62284 (injection procedure for myelography and/or computerized axial tomography, spinal [other than C1-C2 and posterior fossa]) is a starred procedure. According to CPTs Surgery Guidelines, When a starred (*) procedure is carried out at the time of an initial or established patient visit involving significant identifiable services, the appropriate visit is listed with the modifier -25 appended ... Therefore, to be reimbursed for 62284, you must attach modifier -25 (significant, separately identifiable evaluation and management by the same physician on the same day of the procedure or other service) to the E/M service 99220 (initial observation care, per day, for the evaluation and management of a patient ...).
 
Medical necessity, such as the need to evaluate weakness or other symptoms, is required to bill separately for observation. If the patients postprocedure course is uncomplicated, a separate E/M service is not warranted and should not be separately reported. Such observation is part of the normal recovery, even if the patient is being monitored for a long time.
 
When appending modifier -25, you must include complete documentation. To differentiate the services further, the physician may want to document them separately rather than in one report. Although this will take more time, it should help alleviate payment difficulties.