Otolaryngology Coding Alert

Question: Medicare is not paying for an assistant surgeon on craniotomies with removal of acoustic neuroma with 61520 and 61595. Should I appeal these denials?

North Carolina Subscriber

Answer: Codes 61520 (Craniectomy for excision of brain tumor, infratentorial or posterior fossa; cerebellopontine angle tumor) and 61595 (Transtemporal approach to posterior cranial fossa, jugular foramen or midline skull base, including mastoidectomy, decompression of sigmoid sinus and/or facial nerve, with or without mobilization) may or may not allow an assistant surgeon with modifier 80 (Assistant at surgery) on the same CPT code that the primary surgeon used, according to the 2008 Medicare Physician Fee Schedule. Although 61520 indicates Medicare may pay for an assistant surgeon, 61595 has a "1" in column AA, which means, "Statutory payment restriction for assistants at surgery applies to this procedure. Assistant at surgery may not be paid." Code 61520 has an AA indicator of 2, which Medicare defines as, "Payment restriction for assistants at surgery does not apply to this procedure. Assistant at surgery may be paid."

Action: Before you decide to post an appeal, look at the documentation. Does the primary surgeon's operative report support the medical necessity for the listed assistant? If it does, include that information in your appeals- cover letters and highlight the applicable portion on the copied and attached report.

For more tips on claims involving assistant or co-surgery, check out "Two-fers: How to Get Reimbursed for Co-Surgery and Surgical Assistance" available on CD from audioeducator.com.

-- Answers to You Be the Coder and Reader Questions provided by Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J.; Amit Joshi, MSc, senior medical coder for Prexis Health India Ltd. in Pace City II, Gurgaon; and Joanne Schade-Boyce, RDH, MS, CPC, ASC, PCS, in AudioEducator.com's "Anatomy and Coding Essentials for Optimal FESS Reimbursement."