Neurosurgery Coding Alert
Failed Surgery
Question: The patient was intubated and turned prone on the spinal table, but despite several efforts over the next 30-40 minutes, could not be ventilated adequately. The surgery was canceled. General anesthesia was given, but the patient was not prepped and no incision was made. Can the surgeon bill? Ohio Subscriber
Answer: No, the surgeon has no billable charges in this situation.
Medicare and most third-party payers specify that unless the patient has been prepped and an incision started, reduced services (modifier -52) or a discontinued procedure (modifier -53) cannot be claimed. Neither are standby services (99360) appropriate in this situation (and are rarely paid even when legitimately claimed).
For a non-Medicare patient, you may ask the insurer if it is appropriate to submit the surgery code with modifier -56 (Preoperative management only) appended, although this modifier, too, is rarely recognized.
Neurosurgery Coding Alert
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Failed Surgery
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Reporting Re-Explorations
Question: The neurosurgeon performs a re-exploration microdiskectomy at level L4-5 (unilateral) and an initial microdiskectomy [...] - Reader Question:
Gamma Knife
Question: Which is the proper code to report use of a gamma knife during surgery? [...] - Reader Question:
Diagnoses to Support Critical Care
Question: I'm confused by the Medicare instructions recommending that a diagnosis from the 800.0-959.9 range [...] - Reader Question:
Unlisted Procedures
Question: If I want to report a certain procedure for which CPT does not include [...] - News Brief:
No More E/M Documentation Guidelines?
Recently, the AMA announced on its Web site that on May 16, Health and Human [...]
