Neurosurgery Coding Alert

Clearly define what preoperative, intraoperative, and postoperative services your physician offered.

You can avoid denials if you have clarity about services you can report for a neurosurgical procedure. Remember, your physician's services may not be limited to the surgical procedure and may span to the preoperative and postoperative care. To be able to know what services to report, you need to understand the global surgical package. "There are several resources regarding services included in the global surgical package including the AANS Coding Guide," says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center, Edison.

Below are some important and routine services that you will typically consider part of global surgical package:

Preoperative visits: You include preoperative visits in global period when these visits are after your provider has made a decision to operate. This typically implies the day before the day of surgery for major procedures and the day of surgery for minor procedures. This is true unless the decision to operate was made the day before the surgery, which occurs fairly often for urgent cases, such as cases of head injury. "Some insurers include services for the week preceding the surgical date," Przybylski says.

Intraoperative services: The intra-operative services that you will count as part of global surgical package are those that are considered usual and necessary part of a surgical procedure. "While this typically includes the opening and closing of the incision, other services may be included such as imaging," Przybylski says.

Postoperative visits: You include follow-up visits that the patient is asked to make during the postoperative period to monitor and support recovery from the surgery; Complications following surgery: You include any additional medical or surgical services that necessitates your provider performs in the postoperative period because of complications that do not require additional trips to the operating room. Note: This is a Medicare National Correct Coding Initiative (CCI) rule. Treatment of complications in the office setting may be reportable to non-Medicare payers."One should carefully differentiate consequences of the disease process itself from complications directly related to the procedure performed," Przybylski says.

Postsurgical pain management: Make note that any postsurgical pain management that your surgeon provides is inclusive in the global surgical package. Supplies and miscellaneous services: Include all supplies in the global surgical package except for those identified as exclusions. Remember to count on some routine services like dressing changes; removal of any items like sutures, staples, tubes, drains, wires, casts and splints; care of incision(s); insertion, irrigation, and removal of intravenous lines, and urinary catheters; and other similar services.

Resource note: These services included in the global surgical package are defined in Section 40.1 of the Claims Processing Manual (Pub. 100–04, Chapter 12 Physician/Nonphysician Practitioners).