Neurosurgery Coding Alert

Question: What code should be used when a neurosurgeon performs a medical review of x-rays and lab reports for a second opinion without a face-to-face encounter with the patient?

Irene Jumawan
Houston

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Answer: Patricia Boudreaux, CPC, CCS-P, Data Specialist for Tyler Neurosurgical Associates, Tyler, TX, says that the options for coding for reviewing X-rays and lab reports are limited when there is no face-to-face encounter with the patient,. If the neurosurgeon is willing to dictate separate and distinct reports for each X-ray reviewed, the neurosurgeon can bill for re-interpreting the X-ray by using the appropriate CPT code for the X-ray appended with a -26 modifier (professional component) and a -77 modifier (repeat procedure by the same physician). In the report, the neurosurgeon should be sure to mention a second opinion reading was performed.

Otherwise, the entire review can be coded using 99499 (unlisted evaluation and management service).

Note: the Texas Workers Compensation has its own unique code (WC003) for such a review done subsequent to a Second Surgical Opinion (SSO).

The neurosurgeon should check with his or her individual carriers for coverage limitations.