Neurosurgery Coding Alert

Question: The surgeon completed a L5 laminectomy on a patient. Two months later, the patient presented to the emergency department (ED) with headache, neck stiffness, and fever. The surgeon that performed the laminectomy was brought in, and he completed a lumbar puncture while the patient was still in the ED. Should we append modifier 24 or 25 to the ED visit service?

Colorado Subscriber

Answer: Assuming the problem is unrelated to the patient’s initial surgery, you will report the ED visit and lumbar puncture, while appending the correct modifiers. Since the new symptoms might reflect meningitis, these services may be related to the original laminectomy if an incidental durotomy occurred and a subsequent infection developed.

For a separate, unrelated condition, you would first report 99282 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity ...). Modifier alert: You should append modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) to 99282 because the service was for a new problem during the laminectomy’s global period.

Don’t forget: You should only attach modifier 24 to an appropriate evaluation and management (E/M) code when the physician renders the E/M service during a 10- or 90-day postoperative global period for reasons unrelated to the patient’s original surgery. Also, modifier 24 only applies to services your physician performs after the surgical procedure within the global period of that procedure.

Also, the medical record must support that the E/M visit was unrelated to the postoperative care, and the diagnosis should clearly indicate the reason for the unrelated postoperative encounter.

Code 62270: You should also report 62270 (Spinal puncture, lumbar, diagnostic) on this claim. Modifier alert: You should append modifier 79 (Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period) to 62270 to indicate the lumbar puncture was unrelated to the original laminectomy. You would also append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) if the decision to perform the minor procedure of the lumbar puncture was made during the E/M visit.