Neurosurgery Coding Alert

Answer: Code 62289 has been replaced by code 62311 (injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]).

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, reports that some carriers may have a crosswalk feature in their insurance claim processing software. If so, the program will read a CPT 1999 code and automatically re-assign a CPT 2000 code designation. These programs are set up to operate in this manner until March 31, 2000.

As several now-deleted codes have been combined into 62311, this code has a higher relative value than 62289. Sandham reports that if the payer has a crosswalk function programmed into its claims processing software, the neurosurgeon should get paid at the new rate, even when using the old code, until April 1.

Cindy Parman, CPC, CPC-H, principal and co-founder of Coding Strategies, Inc., a Dallas, Ga.-based consulting firm and an advisory board member for the American Academy of Professional Coders, says that not all payers may have crosswalk programming in their claims processing software. If not, claims using older codes may still be paid at the previous rates.

Parman, who worked for a commercial insurance payer for 20 years, further reports that with some third-party payers claims that arrive with new coding may be pended until the payer is ready to update to the new codes. Medicare carriers generally require the implementation of CPT 2000 codes effective April 1. Medicare carriers usually will send out a notice before the end of the year reminding providers that there is a grace period and the new codes should be implemented as of April 1. A subsequent reminder may be sent to providers again some time in February or March. At this time, providers are informed that the new codes will be effective April 1 or on an earlier date that would be specified.

In essence, there is a 90-day grace period at the beginning of every year, Parman says. Parman reports that neurosurgeons should implement new codes when the carriers are ready for them. They should survey their top five or 10 payers to learn when the carriers will be ready for the new codes. Parman suggests sending a general written query asking those payers when CPT 2000 should be implemented. The amount of time a carrier takes to be ready for the codes will vary by locality and carrier. Managed care companies usually send written bulletins to inform providers when new codes should be implemented.

It can be a real revenue loss or delay to use those new codes too soon, Parman says. If the payer isnt ready, the neurosurgeons cash flow can be impacted. A neurosurgeon also has to carefully watch reimbursement rates during the change-over period to ensure that claims are paid at the 2000 rates.

Parman cautions that some Medicaid payers may not be ready until June 1 or July 1, and some workers compensation processors may take much longer to implement new codes because they are not required to update and take new codes in every circumstance. Neurosurgeons should send a written query to Medicaid and workers compensation carriers regarding the time frame for the implementation of new codes.