Neurosurgery Coding Alert

If you-re not reporting them, you-re losing money.

It can be hard to keep track of what you can and can't report based on global surgical package rules. Tack this list up on your wall to ensure you-re capturing all the reimbursement your neurosurgeon is entitled to. Medicare's global package does not include:

- The visit that determines the need of surgical intervention. Tip: This is the decision for surgery, and if the visit occurs on the day before or day of surgery, append modifier 57 (Decision for surgery) to the E/M code to indicate this.

- Unrelated visits for the treatment of a different problem. In this case, you-ll need to append modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) to indicate that the service is unrelated to the surgery.

- Treatment of an underlying condition that is not part of normal recovery.

- Diagnostic testing. For example, a CT scan to look for subdural fluid.

- Other surgeries, including prospectively planned staged procedures, more extensive procedures, or complications with a return to the operating room, or other distinct unrelated surgeries. This depends on your payer, so check individual payer guidelines.

- Surgical trays, when noted.

- Immunosuppressive therapy.

- Critical care services. For instance, a car-crash victim requires emergency surgery for brain trauma but also requires critical care to manage an induced coma. The neurosurgeon can report the applicable brain surgery code(s), and critical care services may also be reported if supported by documentation.

Information provided by Annette Grady, CPC, CPC-H, CPC-P, CCS-P, compliance auditor at The Coding Network, and executive officer on the AAPC's National Advisory Board; and Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery.