Neurosurgery Coding Alert

Question: How do I know whether I can -unbundle- NCCI edits?


Georgia Subscriber

Answer: Each National Correct Coding Initiative code-pair edit includes a correct coding modifier indicator of -0- or -1.- A 0 indicator means that you may not unbundle the edit combination under any circumstances, according to NCCI guidelines. For instance, the edit bundling 61320 (Craniectomy or craniotomy, drainage of intracranial abscess; supratentorial) and 61535 (Craniotomy with elevation of bone flap; for removal of epidural or subdural electrode array, without excision of cerebral tissue [separate procedure]) includes a 0 modifier indicator, meaning that you may never override that particular edit.

An indicator of 1, however, means that you may use a modifier to override the edit if the procedures are distinct from one another. For instance, the physician may have provided the services/procedures at different sessions, at different anatomic locations, or for different diagnoses.

Example: The neurosurgeon performs a laminectomy with foraminotomy (63047, Laminectomy, facetectomy and foraminotomy [unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s)] ...; lumbar), with a hemilaminectomy and diskectomy at a different level (63030, Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar ...). Because the procedures occur at different levels (that is, separate anatomic locations), you may report both procedures.

In addition, you must append modifier 59 (Distinct procedural service) (or another appropriate modifier) to the column 2 code to indicate to the payer that the billed procedures are distinct and separately identifiable. In the above example of a separate laminectomy and hemilaminectomy, you should report 63047 and 63030 with modifier 59 appended.