Neurosurgery Coding Alert

Question: Our neurosurgeon clipped an intracranial aneurysm and created a separate ventriculostomy incision. He followed up with the patient a few days later to check the ventriculostomy for hydrocephalus. He says a seminar leader recently taught that you can bill for the ventriculostomy follow-up visit even though the original procedure happened on the same day as a surgery with a 90-day global period. Is this true?

Missouri Subscriber

Answer: Your physician could be correct, depending on the circumstances.

If he sees the patient for something unrelated to the aneurysm clipping, you could possibly bill the appropriate E/M code for an established patient visit. Choose from 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient ...), assuming your physician saw the patient in the hospital.

Modify it: Check whether the payer requires you to append modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the E/M code as documentation that the service is unrelated to the aneurysm clipping.