Neurosurgery Coding Alert

Question: A general surgeon admits a patient for treatment of a fractured vertebra, and then consults with a neurosurgeon, who follows the patient through the episode of care. Both physicians want to report the discharge. Can they split the discharge billing? If not, who should report it?

Arkansas Subscriber


Answer: It sounds as if the general surgeon is the admitting -attending- physician. Therefore, the attending physician is the physician who reports the discharge code (99238-99239). According to CPT, under instructions for Hospital Discharge Services, -To report concurrent care services provided by a physician(s) other than the attending physician, use subsequent hospital care codes 99231-99233.-

However, if the neurosurgeon performed a surgical procedure for the vertebra fracture (for example, 22523, Percutaneous vertebral augmentation, including cavity creation [fracture reduction and bone biopsy included when performed] using mechanical device, one vertebral body, unilateral or bilateral cannulation [e.g., kyphoplasty]; thoracic), any subsequent hospital care and discharge services would be part of the postoperative global surgical period and there would be no charge for subsequent hospital care or discharge services within the global surgical period.