Neurosurgery Coding Alert

For Medicare, you must meet 2 conditions for correct billing Medicare treats payment for post-op complications, such as infections, differently than insurers that follow CPT guidelines. So, which rules should you follow? Although both CMS (Medicare) and CPT guidelines indicate that the global surgical package includes "typical" postsurgical care, the two sources disagree on what qualifies as typical -- which means you must differentiate your claims depending on the payer you are billing. The difference in a nutshell: To report a separate code to Medicare payers for dealing with a complication within a procedure's global period, the circumstances must meet two conditions: 1. Treatment of the complication must be required at a different session from the original procedure. If the physician can treat the complication during the initial procedure (for instance, control of bleeding or lysis of adhesions), Medicare bundles the complication care to the global surgical package, says Nancy Reading, RN, BS, CPC, director of educational services for the American Academy of Professional Coders. Here's what CMS says: "When a complication described by codes defining complications arises during an operative session - a separate service for treating the complication is not to be reported," according to CMS guidelines in the national Correct Coding Initiative (CCI). CCI guidelines also state, "Codes describing services necessary to address complications - should not be submitted for services rendered at the same surgical session that resulted in the complication. If performed in conjunction with the primary procedure, it would be included in the primary - procedure." As an example, control of bleeding is always an included service if it occurs during the same session as the original procedure, Reading says. If the physician must perform control of bleeding at a later session, with a return to the operating room, you may be able to report it separately (see condition 2). 2. Treatment of the complication must require a return to the operating room. If the physician can treat the complication without a return to the operating room, Medicare bundles the treatment into the initial procedure's global surgical package. Example: Several weeks following parietal craniotomy for brain tumor excision (61510, Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except meningioma), the patient shows signs of infection along the suture line during a follow-up visit in the office. The physician inspects and cleans the wound, changes the patient's dressings and administers antibiotics. In this case, because the physician was able to treat the post-op complication (infection) without a return to the operating room, the visit and treatment are included in the craniotomy's global surgical package and are not separately reportable (or payable), Reading says. In another case: Three weeks following surgery, the physician [...]