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Neurosurgery Coding Alert

CPT 2008:
Spinal Osteotomy Codes Top the List of Neurosurgery Changes
Graft and instrumentation descriptors gain new language CPT 2008 will bring relativel... Read more
CPT 2008:
All the E/M Changes You Need to Know Now
Rumored -e-visit- code is a reality When you open your CPT 2008 manual, you-ll be confr... Read more
CPT 2008 Still Missing 'Transfer of Care' Resolution
One issue not addressed by the AMA in CPT 2008 is a resolution of how to distinguish a con... Read more
Reader Questions:
Not All Allografts Are Equal
Question: The neurosurgeon performs anterior interbody fusion at C5-C6 for a patient wit... Read more
Reader Questions:
Avoid 62 With Instrumentation Claims
Question: Recently, our neurosurgeon worked with an orthopedic surgeon to perform spinal... Read more
Reader Questions:
PLIF and Laminectomy Are Separate
Question: My surgeon argues that we should be able to report a laminectomy (63047) in ad... Read more
Reader Questions:
New Surgeon May Bring Established Patients
Question: We have a new surgeon who is coming over from a nearby county, so of course sh... Read more
You Be the Coder:
How Can You Account for RFTC?
Question: I recently received a procedure note outlining "RFTC for nerve destruction." I... Read more
Part 1:
Straighten Out Your Claims With This Complete Guide to Spinal Instrumentation
When reporting same-session arthrodesis, be careful not to mix -segments- and -interspaces... Read more
Segmental or Not? Here's How to Tell
Nonsegmental posterior instrumentation attaches to the spine at two points--the proximal a... Read more
Conquer Add-on Codes With This Easy Checklist
Always appeal -multiple-procedure reductions- with add-onsReporting -add-on- codes is a sn... Read more
News You Can Use:
One of the Most Troublesome CCI Edits Is Going Away
Retroactive change could mean lost money foundThe national Correct Coding Initiative (CCI)... Read more
Coming Soon:
CPT 2008
Early information suggests significant changes to CPT for 2008, including 242 new codes, 2... Read more
READER QUESTIONS:
53 Applies for Interrupted Lumbar Puncture
Question: During lumbar puncture, the patient experienced leg numbness and paresthesia. Th... Read more
READER QUESTIONS:
Stick With 99218-99220 for 8 Hours or Fewer
Question: We have a longstanding argument in our office regarding the proper use of observ... Read more
READER QUESTIONS:
Making the Most of Telephone Time
Question: I-ve been told that I cannot be paid for time the physician spends with a patien... Read more
You Be the Coder:
Can a Craniotomy Be 'Bilateral'?
Question: The surgeon performed frontal craniotomies on both the left and right sides to e... Read more
Check These 5 Items to Apply Modifier 57 Properly
Remember that the global period begins 1 day prior to surgery When an E/M service pro... Read more
Global Periods Made Easy
Modifiers and more depend on surgical package timeline The global period's length for... Read more
Correction:
Modifier 57 Is the Answer for 'Major' Surgery, Same-Day E/M
As discussed elsewhere in this issue (see -Check These 5 Items to Apply Modifier 57 Prop... Read more
Reader Question:
Treatment, Tests Don't Rule Out a Consult
Question: Can I still report a consultation if the consulting physician initiates treatm... Read more
Reader Question:
Overlapping Critical Care Could Lead to Denials
Question: Can two physicians claim critical care for the same patient? California Sub... Read more
Reader Question:
Add-on Code Describes Chemo Disc Implantation
Question: Recently I received an operative report in which the surgeon describes impla... Read more
Reader Question:
Endoscopic-to-Open Surgery Calls for 1 Code Only
Question: Our surgeon attempted to remove a pituitary tumor using the endoscope (62165... Read more
You Be the Coder:
What's the Code for Mysterious X-Stop?
Question: I-ve recently come across an operative report for an -X-STOP- procedure. I-ve ... Read more
Follow 6 Easy Steps to Distinguish Kyphoplasty From Vertebroplasty
Crossing spinal regions calls for a single -primary- codeIf you can't tell percutaneous ve... Read more
Vertebroplasty and Kyphoplasty Codes
Vertebroplasty codes cover thoracic, lumbar and each additional thoracic or lumbar vertebr... Read more
Bonus Tip:
Vertebro/Kypho Plasty Include Bone Biopsy
When reporting 22520-22522 or 22523-22525, you won't code separately for bone biopsy (2022... Read more
Modifier 59 Made Easy:
Look for a Separate Location/Session
Be sure to check CCI for a -1- modifier indicator Properly applying modifier 59 (Distinct ... Read more
Go With the Flow to Make Modifier 59 Decisions Easy
If you-re looking for an easy way to determine if you should append modifier 59 (Distinct ... Read more
READER QUESTIONS:
Count Fusions, Not Vertebrae
Question: If the surgeon fuses vertebrae L2 through L4, should I report 22612/22614, or 22... Read more
READER QUESTIONS:
Locum Tenens Solutions in 3 Steps
Question: One of our physicians will be out of the office for an extended period, and a fi... Read more
READER QUESTIONS:
Cranial Graft Holds Multiple-Code Opportunities
Question: Our surgeon treated a patient for evacuation of an intracranial hematoma. To min... Read more
You Be the Coder:
What Accompanies 61795?
Question: I receive frequent denials from our Medicare payer when reporting 61795. When I ... Read more
Answer These Coding Questions Before Filing Radiology Claims
Experts tackle fluoroscopy and x-ray coding challenges When your neurosurgeon uses he... Read more
Experts Answer These 2 FAQs on ICD-9 Coding
Don't limit yourself to 1 diagnosis code -- because it could be the wrong one If you ... Read more
Check ICU Encounters for Critical Care Opportunities
This audit technique can lead you to extra cash When you see certain phrases in your ... Read more
Reader Questions:
Look to 310 and 331 for Mild Cognitive Impairment
Question: What diagnoses do carriers usually accept for mild cognitive impairment? Ten... Read more
Reader Questions:
File 'Unlisted' for Extremity Chemodenervation
Question: Can we bill more than one unit for chemodenervation of the eccrine glands (oth... Read more
Reader Questions:
Get More Specific With Dystonia Diagnosis
Question: One of our coders says we can no longer report diagnosis 333.7. What should we... Read more
Reader Questions:
729.1 Is Your Best Bet for Myofascial Pain
Question: What diagnosis should I use for myofascial pain or myofascial discomfort? So... Read more
Reader Questions:
Don't Leave Telephone Codes off the Hook
Question: Our neurosurgeon receives nonemergent calls after 10:00 p.m. We are considerin... Read more
Reader Questions:
Follow These Rules for Prescription Writing
Question: I heard that there's a code we can bill (and be paid for) to indicate when our... Read more
You Be the Coder:
Established Patient Consults in ED
Question: If another physician calls our surgeon to the emergency department (ED) for a ... Read more
Check Op Sites Before Coding Tumor Excision/Hematoma Evacuation
If you recognize separate sites, you could ethically earn more $$ on the claim Patients ... Read more
Psych Tests Bundled Into Functional Brain Mapping Code
There still isn't a list of accepted diagnoses for 96020 There is good news surrounding C... Read more
Clip & Save ~ Brain Tumor Symptoms Aren't All in Patients' Heads
Headaches are common, but other problems could signal trouble, too Did you know that some... Read more
Reader Question ~ Established Care Plan a Must for Incident-to Billing
Question: If a Medicare patient sees one of our nonphysician practitioners (NPPs) for an E... Read more
Reader Question ~ Know Surgeon's Role, Then Choose Admit Code
Question: The neurosurgeon admits a patient with neck injuries through the emergency depar... Read more
Reader Question ~ Most Second-Opinion Visits Are Not Consults
Question: Since CPT no longer carries the confirmatory consultation codes, how would I rep... Read more
Reader Question ~ Leave Modifier 50 Off Decompression Claim
Question: An established patient with lumbar stenosis reports to the surgeon. After a leve... Read more
Reader Question ~ Observe PHI Rules for Patients and Staff
Question: How should a medical facility handle employees- access to their own medical reco... Read more
You Be the Coder ~ Bone Debridement During a Facetectomy
Question: A patient with osteomyelitis of the spine reports for treatment. The surgeon per... Read more
Check Bone Graft Method on Your PLIF Claims -- or Leave Money on the Table
The surgeon must perform a bone graft to complete a standard PLIFPosterior lumbar interbod... Read more
Leaving Laminectomy Off PLIF Claim? Not So Fast
Some of these laminectomies are separately reportable When you-re scouring your surgeon's... Read more
Knowing E/M Status Is Vital to Your Modifier 25 Claim
Answer to -separate vs. inherent- question is key to successful claims If the neurosurgeo... Read more
Reader Questions:
Modifier 59 Paves the Way for Arthrodesis-Laminectomy Pay
Question: Our surgeon performed a posterior interbody arthrodesis for a patient at L1-L2 a... Read more
Reader Questions:
Decide Surgeon Focus, Then Choose Discectomy Region
Question: Our physician performed a pair of discectomies: one at C5-C6 and another at C7-T... Read more
Reader Questions:
You'll Need Modifier Help for Bilateral Laminotomies
Question: When the neurosurgeon performs a bilateral laminotomy, can we apply modifier 50 ... Read more
Reader Questions:
'Open-Door' Laminoplasty Closes Door on 63001 Reporting
Question: What is an -open-door- laminoplasty, and how should I code this procedure?Missis... Read more
Reader Questions:
Intraoperative EMG Calls for Surgery Diagnosis
Question: The neurosurgeon monitors a patient's nerves while she is in the operating room ... Read more
Reader Questions:
Use New Code for Functional Brain Mapping
Question: The neurosurgeon performs functional brain mapping on a patient. How should I re... Read more
You Be the Coder:
Don't Code AV Malformations as Complex Aneurysms
Question: The neurosurgeon repaired an intracranial arteriovenous (AV) malformation on a p... Read more
Here's Why You Can Resubmit Those Denied Craniotomy Claims
What neurosurgery coders must know about NCCI 13.1 The National Correct Coding Initiative... Read more
Increase Your Coding Savvy With Terminology Knowledge
Get to know the spine in-depth, and the right codes will follow Do you know your facet fr... Read more
Nail Down E/M Coding Rules to Select the Right Level Every Time
Does the H/P have a time limit? The answer may surprise you The financial health of many ... Read more
Reader Questions:
Consider Dx Range for Post-Traumatic Headache
Question: What are the best diagnosis codes for an acute post-traumatic headache and a chr... Read more
Reader Questions:
Only 1 Physician Should Report Discharge
Question: A general surgeon admits a patient for treatment of a fractured vertebra, and th... Read more
Reader Questions:
EVD Coding Depends on Circumstances
Question: Our neurosurgeon performed an external ventricular drain (EVD) placement. Which ... Read more
Reader Questions:
Check Number of Incisions, Generators for RNS/IPG Replacement
Question: Our surgeon treated a patient with medically intractable epilepsy by replacing h... Read more
Reader Questions:
Use 'RT' and 'LT' to Denote Separate Sides
Question: Our surgeon treated a patient who was four months status post a right-sided L5-S... Read more
You Be the Coder:
How Should We Bill Fusion With Methylmethacrylate?
Question: Our neurosurgeon treated a patient who had a spinal metastatic cancer diagnosis.... Read more
4 Strategies for Superior Spine Coding Reimbursement
Follow the experts- advice to submit clean spine claims every time Sometimes, even the ... Read more
Your Physician's Notes Reveal Diagnosis Codes -- You Just Have to Know Where to Look
If the surgeon does not circle a diagnosis, it may be up to you to find one Don't let a... Read more
Let This Chart Help Decipher Vertebral Anatomy Terms
Match the site to the documentation and you-ll choose the right code every timeIf you have... Read more
Reader Question:
Include "Gallie" in Fusion Code
Question: Our neurosurgeon performed a C1-2 posterior fusion using the -Gallie- techniqu... Read more
Reader Question:
Look to Excision Cause Before Billing Schwannoma Removal
Question: How should we report an excision/resection of an L5 Schwannoma? We are trying ... Read more
Reader Question:
Payers May Not Accept Modifier 56
Question: We recently sent a patient to her primary care physician (PCP) for a preoperat... Read more
Reader Question:
Be Aware of In-Office NCS Testing Rules
Question: A product representative recently sold us nerve conduction study equipment tha... Read more
Reader Question:
Consider 61250 for Burr Hole
Question: Our surgeon performed a right frontal burr hole with evacuation of pneumocepha... Read more
Reader Question:
Conquer WC Denials With Separate Notes
Question: A patient came in for one diagnosis for his workers- comp coverage. He also sa... Read more
Reader Question:
Continue Using T Code for X Stop Procedures
Question: I have been holding my claims for the surgeon's work inserting an X stop devic... Read more
Reader Question:
Report X-Ray Code if Mini-C-Arm Stores Images
Question: Our clinic purchased a mini c-arm, and it is the only x-ray unit in the buildi... Read more
You Be the Coder:
Use Modifier for Separate Plates
Question: Our neurosurgeon placed two different cervical plates on a patient's spine. Ca... Read more
OP REPORT EXAMINATION ~ Accurately Reporting Co-Surgery Can Mean the Difference Between 62.5% Payment and Nothing
Pin down which physician performed each portion of co-surgery When two physicians work as... Read more
Coder Wins Back $300,000 in PLIF/Fusion Reimbursement
Fight those spine bundle denials whenever possibleYou may have won out over edits that mad... Read more
NCCI 13.0 Grabs on to New CPT Codes and Institutes Edits
New edition targets surgical codes With more than 9,000 changes in the latest National Co... Read more
Follow Neurosurgery Acronyms to Decipher Op Reports
Use these tips to better translate abbreviations into codes Do you know your SDH from you... Read more
Let This Tool Guide You When You Encounter Acronyms
We polled our experts and established a list of the most frequently documented abbreviatio... Read more
READER QUESTION ~ Consider Options for Myofascial Pain Dx
Question: Which diagnosis should I use for myofascial pain or myofascial discomfort? South... Read more
READER QUESTION ~ Double-Check Code for Sacrococcygeal Injection
Question: Which code should I report when the physician administers a steroid injection in... Read more
READER QUESTION ~ Look to 95951 for Epilepsy Monitoring
Question: What is the most accurate diagnosis for epilepsy monitoring that lasts 13 hours?... Read more
READER QUESTION ~ Confirm Documentation for Cognitive Deficits
Question: Which diagnosis code should we report when a traumatic brain injury causes cogni... Read more
YOU BE THE CODER ~ Insurers May Balk at Paying Multiple Units of 77002
Question: When we perform multiple injections at the same time, can we report 77002 (76003... Read more
First Decide Aneurysm's Complexity, Then Choose a Surgical Code
Hint: If the aneurysm exceeds 1.5 cm, it's complex When the neurosurgeon performs surgery... Read more
Opt for Modifier 22 When Your Surgeon Repairs 'Difficult' Simple Aneurysms
Remember: You should choose a code based on the complexity of the aneurysm, not the surger... Read more
Squeezing Through E/M 'Loophole' Could Create Trouble on Claims
Here's why coding 99215 regardless of medical necessity could cost you Coders, beware: So... Read more
QUICK QUIZ ~ Here's the Fast Way to Find Out if the Patient Is New
Remember 3-year rule when addressing patient status Are you having trouble separating... Read more
READER QUESTION ~ Code Exploration When Surgeon Performs Fusion Mass Biopsy
Question: If our neurosurgeon has to redo a lumbar laminectomy at two interspaces and he e... Read more
READER QUESTION ~ Beware NCCI Bundles When You're Coding for Kyphoplasties
Question: Our neurosurgeon recently performed a thoracic kyphoplasty on a patient with a c... Read more
READER QUESTION ~ POS Drives CPO Coding
Question: I am confused about how to code care plan oversight (CPO) claims. Can you explai... Read more
YOU BE THE CODER ~ Hematoma Evacuation With Shunt Placement
Question: A patient with recurrent subdural hygroma (CSF fluid collection) and a subdural ... Read more
CPT 2007 UPDATE ~ Welcome These New Category III Codes for 'X Stop' Procedures
Introduction of -T- code a good sign for this spinal stenosis treatment January is a ... Read more
NEWS YOU CAN USE ~ Meeting to Address Effectiveness of Spine Fusion
Some fret over potential impact on payments for procedure At the behest of Medicare, ... Read more
CPT 2007 UPDATE~ CPT Applies More Logic to Radiologic Guidance Codes
New manual groups guidance codes by modality The CPT Codes 2007 manual holds many ch... Read more
Make Sure Your Modifier 59 Claims Include Evidence of Separate Procedures
Experts recommend that you ask payers for modifier policy specifics When your neurosu... Read more
READER QUESTION ~ Consider Drain Placement Part of Craniotomy Package
Question: An epileptic patient reported to the office for a craniotomy. During the procedu... Read more
READER QUESTION ~ Look to Kyphoplasty Codes for Balloon-Aided Vertebroplasty
Question: I have a confusing claim in front of me. The neurosurgeon's notes indicate that ... Read more
READER QUESTION ~ You Might Be Able to Report Halo Vest Placement With Laminectomy
Question: The neurosurgeon performed a unilateral cervical laminectomy at segments C4-C5 a... Read more
READER QUESTION ~ Abandon Location Concerns When Coding Observations
Question: Our neurosurgeon met a patient at the hospital and performed a  level-two o... Read more
YOU BE THE CODER ~ Injections With Electromyographies
Question: The neurosurgeon performed a unilateral needle electromyography on three extremi... Read more
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