Neurosurgery Coding Alert

A great deal of potential reimbursement is not pursued because many neurosurgeons believe that after a surgical procedure has been performed, any postoperative care that falls within the global surgical period, even if the care is not related to the initial surgery, may not be billed separately. According to CPT 2000 guidelines, the package for surgical procedures is defined as: Listed surgical procedures include the operation per se, local infiltration, metacarpal/digital block or topical anesthesia when used and normal, uncomplicated follow-up care.

Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno, says that carriers understandably are wary of billings that may appear to be double dipping (i.e., separate billings for services that already have been calculated into the amount paid for the surgical package). There are instances, however, in which additional billing during the global period is appropriate.

Use Modifier -78 for Surgery Complications

Routine complications following surgery such as infection, bleeding, and perforation are included in the global package for the surgery. This may require such procedures as dressing changes, topical care and bedside debridement. But depending on the carrier and the circumstances, the surgical procedures for nonroutine complications may be billable.

Laurie Castillo, MA, CPC, president of Physician Coding and Compliance Consulting in Manassas, Va., and a coding expert in neurosurgery, offers this example: A neurosurgeon performs a craniotomy (61533, craniotomy with elevation of bone flap; for subdural implantation of an electrode array, for long term seizure monitoring) on a patient with epilepsy (345.9). The patient develops a hematoma, calling for a new primary diagnosis code 997.02 (iatrogenic cerebrovascular infarction or hemorrhage).

The patient is brought back to surgery to drain the hematoma. A Jackson/Pratt drain is placed to remove the hematoma (61154, burr hole[s] with evacuation and/or drainage of hematoma, extradural or subdural). Code 61154 would be billed with a -78 modifier (return to the operating room for a related procedure during the postoperative period) to state that it was a complication due to the original surgery.

Anita Daye Foster, MA, CPC, CCS-P, senior vice president of coding and operations for The Coding Network in Hawthorne, Calif., adds that because the -78 modifier indicates a complication of the original surgery, reimbursement will be intraoperative only. This means the carrier will pay a partial surgical allowance covering only the new procedure, not preoperative or postoperative costs.

Use Modifier -79 for Unrelated Procedures

A patient who recently has undergone neurosurgery may develop a new and unrelated problem that also requires surgical treatment. If this new surgery is performed during the 90-day global period for a previous surgery, modifier [...]