Neurosurgery Coding Alert

Question: Can our surgeon gain separate payment for placement of Gardner-Wells tongs to stabilize the head during cervical procedures (corpectomy, fusions, etc.)? New York Subscriber Answer: No, you should not report 20660 (Application of cranial tongs, caliper or stereotactic frame, including removal [separate procedure]) separately for the tongs in the cases you cite. CPT designates 20660 as a "separate procedure," which establishes that this code is incidental to any related, more extensive procedure that the surgeon provides during the same session (including corpectomy, fusion and others). Should your surgeon cite a separate indication for placement of the tongs (in other words, a distinct ICD-9 and medical necessity), you could bill 20660 separately with modifier 59 (Distinct procedural service). Don't be surprised, however, if the payer initially rejects the claim.