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Neurosurgery Coding Alert

Brace yourself for coding consult alternative
New rule means simpler coding, but less pay. The rumor about consultation codes becomi... Read more
Report only 1 craniotomy code, but add-ons might apply
Study this scenario to see if you catch all the extra code opportunities. Craniotomy c... Read more
Watch these 2 areas for critical care coding success
Understanding ‘critically ill’ and ‘high complexity’ start you o... Read more
Location Isn't Always the Critical Care Answer
Physical status is your key. Critical care is usually provided in the critical care un... Read more
Reader Questions:
Remember modifier for burr hole follow-up
Question: A patient presents with a subdural hemorrhage and requires a craniotomy. A few... Read more
Reader Questions:
Check out bone excision for bony inion removal
Question: Our neurosurgeon plans to remove a prominent inion by drilling. I can’t ... Read more
Reader Questions:
Payer might want more specific diagnosis
Question: I billed facet and epidural steroid injection codes 64475 and +64476 with fluo... Read more
Reader Questions:
Lesion size determines 'simple' or 'complex'
Question: What is the difference between simple and complex lesions during stereotactic ... Read more
Reader Questions:
Yes, you code neuroendoscopic biopsy
Question: How should I code for neuroendoscopic biopsy? In the first case, our surgeon p... Read more
Reader Questions:
Try 61597 for suboccipital craniectomy
Question: Our neurosurgeon completed a suboccipital craniectomy, C1 laminectomy, and res... Read more
Reader Questions:
64999 is only option for transnasal endoscopic resection
Question: Some of our physicians suggested we submit the skull base codes for a transnas... Read more
Reader Questions:
22899 or 64999 Could Apply to Hardware Pain Injection
Question: I have a procedure report that states, “Injection of posterior lumbar ha... Read more
You Be the Coder:
Double Check Before Coding 724.4
Question: What are the correct diagnosis codes for lumbar spondylosis with radiculopathy... Read more
CCI 15.3 hammers moderate sedation reporting, nixes IDET edits
Also: Pay special attention to switched pairs so you'll submit the right codes. The lates... Read more
Learn 3 easy steps to distinguish between 61790 and 61791
An anatomy lesson will point you in the right direction every time. How do you tell the d... Read more
Master multi-provider reporting or risk losing big pay
Try your hand at deciding between 62, 80, 81 -- or something else. Knowing when to c... Read more
Reader questions:
Examine reexploration, decompression options
Question: The surgeon completed re-exploration, debridement of infected lumbar wound and ... Read more
Reader questions:
Code separately for follow-up discectomy
Question: The surgeon completed anterior exploration with biopsy and diagnosed an anterio... Read more
Reader questions:
'unlisted' applies to X-stop removal
Question: Our surgeon is removing his first X-stop. How do I code that in addition to a d... Read more
Reader questions:
353.0 or 344.9 = long thoracic nerve palsy diagnosis
Question: What is the best diagnosis code for long thoracic nerve palsy? Oregon Subscribe... Read more
Reader questions:
Skip bilateral modifiers with 63056
Question: Our neurosurgeon used a transpedicular approach to complete bilateral spinal co... Read more
Reader questions:
Report 63741 for shunt without laminectomy
Question: Our neurosurgeon placed a lumboperitoneal shunt with a laminectomy in February ... Read more
Reader questions:
Choose between 20550 and 20551 for epicondyle injections
Question: How should I code bilateral lateral epicondyle injections? Minnesota Subscriber... Read more
You be the coder:
Correctly code 2 spinal plates
Question: Our neurosurgeon placed one plate at C3-5 and a second plate at C6-7. How do we... Read more
Yes, you can code separately for ICP monitoring and EVD caths -- sometimes
Stop by these 5 checkpoints on the road to 61107, 61210 coding success. An extra $350 in ... Read more
Jump-Start Neurostimulator Coding With 6 Details
These questions solve your 63650, 63655, or 63685 dilemma. Check off the relevant info of... Read more
ICP, EVD:
Same, but Different
The purpose of a ventricular catheter and ICP monitor can overlap, but they might also ser... Read more
4 rules help you correctly call multi-provider modifiers
Check the work, not dictation, to prevent 42% or more in losses. With carriers paying 62 ... Read more
Reader Questions:
Craniotomy includes duraplasty closure
Question: I'm coding for hemicraniectomy and duraplasty with diagnoses of post-trauma sta... Read more
Reader Questions:
62287, not 63056, is for lumbar coblation
Question: Our neurosurgeon suggested that we bill 63056 for the coblation of L4-L5 and co... Read more
Reader Questions:
Document special reason for halo pin replacement
Question: Our surgeon performed halo pin replacement. Can we bill for this, or is it cons... Read more
Reader Questions:
Biopsy with no burr hole = 61500
Question: Our surgeon biopsied a lesion from the skull, but did not perform a craniectomy... Read more
You be the coder:
Know when to code instrumentation removal
Question: If the surgeon takes out the instrumentation before he performs a repeat fusion... Read more
3 details you need for neurostimulator coding success
Do your homework up front to save backtracking time -- or denials -- later. A well d... Read more
Consultation pay might end, but don't panic quite yet
Codes will still be there, just don't use them for Medicare. In the July 13 Federal Regis... Read more
Follow clues to narrow choices for evoked potentials tests
This chart maps anatomy, reason, workings, pitfalls to 92585, 92586 ... and more. You can... Read more
Correction
"Master Multiple Procedure Coding by Taking This Multi-Level Spinal Surgery Challenge" in ... Read more
Reader Questions:
Graft details help set cage change code
Question: Our neurosurgeon has scheduled exploratory surgery because he believes the pati... Read more
Reader Questions:
Fiducial markers and return scan
Question: My neurosurgeon placed fiducial markers for a deep brain stimulator for four da... Read more
Reader Questions:
Include all codes for fusion/fixation surgery
Question: Our neurosurgeon completed right L3-4 translumbar interbody fusion with cage an... Read more
Reader Questions:
Discectomy with fusion doesn't mean full pay
Question: When our surgeon completes a discectomy with fusion, Medicare pays the full amo... Read more
Reader Questions:
Yes or no: Modifiers for 64612-64613?
Question: When I report 64612 and 64613 to Medicare at the same time, I'm unsure what mod... Read more
You be the coder:
Multiple 61510 coding
Question: My physician coded 61510 x 3 because the tumor overlapped several areas. His do... Read more
CCI 15.2 Hits Neurosurgeons With 100+ Edits
Pay close attention to new round of bundles if your docs rely on fluoroscopy. CCI 15.2 we... Read more
ICD-9 Gives You More Choices for Brain Injury Coding
Check out V80.01 and V80.09 for special screenings. The newest edition of ICD-9 changes g... Read more
Watch Signs, Symptoms, and More for CTS Success
Follow these 5 steps to make carpal tunnel claims simple. Coding a case of carpal tunnel ... Read more
READER QUESTIONS:
Choosing Between Office and Admission Codes
Question: Our physician saw a patient in the office and decided to admit her to the hospi... Read more
READER QUESTIONS:
Stick With the Correct Code, Not RVU
Question: My physician wonders why +63044 does not have any relative value units (RVUs); ... Read more
READER QUESTIONS:
Want to Bill Prolonged Time? Read This First
Question: If the neurosurgeon spends a prolonged amount of time with the patient during a... Read more
READER QUESTIONS:
Watch Documentation for Co-Surgery Cases
Question: Our neurosurgeon worked with an orthopedic surgeon during a patient's spinal fu... Read more
READER QUESTIONS:
Confirm Spinal Block Location for Fluoro Code
Question: Can I report fluoroscopy in conjunction with pain management blocks? If so, wha... Read more
READER QUESTIONS:
Tethered Cord Release Includes Tag Removal
Question: My neurosurgeon released a tethered cord under the microscope, then excised a d... Read more
READER QUESTIONS:
Know Nuances Between Schwannoma and Neurofibroma
Question: What is the difference between a schwannoma and neurofibroma? California Subscr... Read more
You Be the Coder:
Wound Exploration During Hematoma Removal
Question: Our neurosurgeon removed an epidural hematoma at C7 two days after completing a... Read more
Defeat Intracranial Aneurysm Surgery Denials by Pinpointing Location and Complexity
If the aneurysm meets one of these criteria, you can boost your simple surgery code to a ... Read more
Make the Grade With This Gamma Knife Surgery Checkup
Improve your reimbursement chances by applying modifier 58 in this situation. When your s... Read more
Include 20660, +61795 in Stereotactic Radiosurgery Code
It's not all bad news: here's what you can bill separately. You should not claim 20660 (A... Read more
On the Cutting Edge:
Hold Off Reporting 86999 for Every PRP Injection
Don't miss reporting blood platelets placement in this situation. Scouring your CPT book ... Read more
READER QUESTIONS:
Get to the Bottom of 'Gallie' Technique
Question: Our neurosurgeon's documentation states he performed a C1-2 posterior fusion us... Read more
READER QUESTIONS:
Catch This 'XXX' and '000' Global Period Difference
Question: What's the difference between an "XXX" global period and a "000" global period?... Read more
READER QUESTIONS:
Sharpen Your Second Surgery Coding Skills
Question: One of our patients underwent a bilateral lumbar laminectomy, decompressive L3-... Read more
READER QUESTIONS:
Number of Fusions Matter, Not Number of Vertebrae
Question: If the surgeon fuses vertebrae L2 through L4, should I report 22612/+22614, or ... Read more
READER QUESTIONS:
Discover What You Can Report With 61795
Question: I receive frequent denials from our Medicare payer when reporting +61795. When ... 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? South... Read more
You Be the Coder:
Radiofrequency Thermal Coagulation
Question: I recently received a procedure note outlining "RFTC for nerve destruction." I ... Read more
Hold Onto Your Subcutaneous Cranial Bone Graft Dollars With This 2-Part Strategy
If youre not keeping track of add-on codes, you could be setting your claim up... Read more
4 Q&As Solve Your Admission, Subsequent Care Questions
Heres when you can claim a consult rather than an admit/subsequent care code. ... Read more
Noncovered Procedure? A Signed ABN Can Make a Difference
Sharpen your modifier GA, GY, and GZ skills to go along with your ABN. ... Read more
READER QUESTIONS :
Neurostimulator + 2 Electrode Arrays = 2 Units
Question: Our neurosurgeon implants a spinal neurostimulator. The neurosurgeon... Read more
READER QUESTIONS :
Iron Out Co-Surgery Details
Question: A thoracic surgeon and neurosurgeon work together during arthrodesis... Read more
READER QUESTIONS :
Highlight These Suture-Line Infection Tools
Question: A patient undergoes a parietal craniotomy to excise a brain tumor. S... Read more
READER QUESTIONS :
Double Burr Holes? This Could Mean Double Codes
Question: My neurosurgeon performed a burr hole evacuation (bilateral) and pla... Read more
READER QUESTIONS :
Factor In Range of Service in This Obese Patient Case
Question: Recently, our surgeon performed spinal fusion (22630) on an extremel... Read more
You Be the Coder :
Mayfield Head Holder/Prongs
Question: When our neurosurgeon performs a cervical foraminotomy, can we charg... Read more
5 Simple Steps Shore Up Your Shunting Placement, Revision, and Replacement Claims
Watch out: Not applying this modifier could mean missing out on $220. ... Read more
Clip 'n' Save:
Sharpen Your Shunt Coding Skills With This Chart
Before selecting a code for initial shunt placement, you should read your neur... Read more
Focus on Doc's Intent to Quickly Solve Consult, Referral Riddle
A letter of findings to the first physician doesnt always equal a consult. ... Read more
Don't Get Burned By Bilateral Modifier Guidelines
Number 2 in column Z? Strike out modifiers 50, RT, LT as options. N... Read more
Reader Questions:
MD Must Be Involved in Stereotactic Radiosurgery
Question: Our neurosurgeons are involved with the radiation oncologists for th... Read more
Reader Questions:
Cut Down on Co-Surgery Mistakes
Question: Our neurosurgeon is treating a workers compensation patient schedule... Read more
Reader Questions:
+22851 Covers Different Devices
Question: I really liked the article \"Safeguard Your Spinal Instrumentation C... Read more
Reader Questions:
Hold Off Separately Reporting Fluoro
Question: When our surgeon performs spinal fusions, he often dictates using fl... Read more
Reader Questions:
Go Procedure-by-Procedure Coding This Scenario
Question: My physician performed a bilateral posterior fossa craniectomy with ... Read more
You Be the Coder:
Control of Bleeding During Surgery
Question: I have an op report in which the neurosurgeon specifies that he perf... Read more
Master Multiple Procedure Coding By Taking This Multi-Level Spinal Surgery Challenge
1 or 2 units? The code definition can make it easy for you to decide. ... Read more
CCI 15.1 Update:
Adhere to These Osteotomy,Laminectomy Edits
Youll need a modifier on this code pair to bust bundle. Be cautious... Read more
Coding Quiz:
Ace Neuroendoscopy Claims With This 5-Question Quiz
Warning: A modifier shouldnt be a shoo-in when surgeon converts to an open pro... Read more
Coding Quiz Answers:
Make Neuroendoscopic Claim Over-Reporting a Thing of the Past
You can apply modifier 22 only in this situation. Confidently skip ... Read more
READER QUESTIONS:
Same-Day, Different-Specialty E/M Services OK
Question: Sometimes patients see two of our physicians on the same day. Can I ... Read more
READER QUESTIONS :
Include Halo Adjustment in Global
Question: Is there a code for adjusting a cervical halo without anesthesia? ... Read more
READER QUESTIONS:
New Patient Not Based on Creating Medical Record
Question: CPT says a new patient is one whom we have not seen in the past thre... Read more
READER QUESTIONS:
Get Your Modifier Reductions Straight
Question: Using the Resource-Based Relative Value Scale (RBRVS), what are the ... Read more
READER QUESTIONS:
CNS = NP = PA for CPT, but Check Law
Question: Does a certified nurse specialist (CNS) count as a nurse practitione... Read more
READER QUESTIONS:
You Should Be Extending Fever Dx to 5th Digit
Question: One of our Medicare patients came to us yesterday with a high fever,... Read more
READER QUESTIONS:
Make the Levels Versus Interspaces Distinction
Question: If the surgeon fuses vertebrae L1 through L3, should I report 22612,... Read more
READER QUESTIONS:
Try Your Hand at Transphenoidal Hypophysectomy
Question: My physician did a transphenoidal hypophysectomy with an ENT, who sa... Read more
You Be the Coder :
Check This Decompression, Bony Lesion Difference
Question: One of our physicians performed a partial corpectomy at T-11 and a p... Read more
Safeguard Your Spinal Instrumentation Claims by Busting These 5 Myths
Eradicate same-session arthrodesis errors by not mixing -segments- with -interspaces.- ... Read more
News You Can Use:
Wrong Spinal Level Can Mean No Reimbursement Whatsoever
Here's how to capture pay if wrong location is due to extra vertebrae. If your neurosur... Read more
Focus On Fixation Points to Master Segmental vs. Non-Segmental
Here's why vertebral segments matter. Want picture perfect spinal instrumentation claim... Read more
Dodge Double-Billing Interp Claim Mishaps With This Advice
You may not always be able to report CPT code, but discover this big benefit. When your... Read more
READER QUESTIONS:
Evaluate This CPT Errata and Update Your Manual
Question: The inside cover jacket of my CPT manual says that the definition for modifier... Read more
READER QUESTIONS:
Avoid +61795 Errors By Checking CCI Edits
Question: Is +61795 for intraoperative navigation or for planning prior to surgery? Kan... Read more
READER QUESTIONS:
Glean the Best Way to Report Gliadel Wafers
Question: How can I code for placement of Gliadel Wafers? Is there a dedicated code for ... Read more
READER QUESTIONS:
Get The Most Out of This E-Scribe Bonus
Question: I heard that physicians may receive bonuses for e-prescribing. What codes woul... Read more
READER QUESTIONS:
Take the Guesswork Out of Coding X-Stop Procedures
Question: We have never done an X-stop procedure. How should I report it, and what is th... Read more
You Be the Coder:
Check for Neoplasm When Reporting 63270, 63275
Question: My doctor states he did hemilaminectomy with resection of extradural mass loca... Read more
Look for These Terms to Keep Laminotomy Straight From Laminectomy
These -occasional- modifiers let you report both procedures at the same level. You can ... Read more
CCI 15.0 Update:
Include New Radiosurgery Code as Part of 20 Neuro Procedures
Tip: Adhere to new arthroplasty bundles by following CPT guidelines. Don't panic when y... Read more
News You Can Use:
Medicare Lowers Conversion Factor to $36.0666 for 2009
But you won't feel as much of a crunch, thanks to a budget neutrality adjustment. CMS h... Read more
Reader Questions:
Count Fluoro As Part of the Major Procedure
Question: When our surgeon performs spinal fusions, he often dictates the use of fluoros... Read more
Reader Questions:
Use Unlisted for Stabbing in the Back
Question: We have a patient who was stabbed in the back, and my doctor removed the knife... Read more
Reader Questions:
Define 'Mutually Exclusive' and 'Bundled'
Question: Would you explain what the differences are between mutually exclusive and "col... Read more
Reader Questions:
Draw the Line Between Segmental, Nonsegmental
Question: How can I determine segmental from nonsegmental spinal instrumentation? North... Read more
Reader Questions:
Post-Op Care Includes Halo Adjustments
Question: How can we code for adjusting a cervical halo without using anesthesia? India... Read more
Reader Questions:
Turn to Twist Drill/Burr Hole for Monitor Placement
Question: What is the correct code for placement of right frontal Camino intracranial pr... Read more
You Be the Coder:
Abbott Allograft Bone for ACDF
Question: Our neurosurgeon used "Abbott" allograft bone for an anterior cervical discect... Read more
CMS Draws the Payment Line for IDET, Other Thermal Intradiscal Procedures
Here's what to do if your physician performs these services for Medicare patients. If ... Read more
Bust 3 Myths About How Global Rules Affect Your Postop Coding
CMS and CPT disagree about one key term. If you automatically assume you can't separate... Read more
Coding Quiz:
Vertebroplasty vs. Kyphoplasty: Are Your Claims Covered?
Find out in 5 minutes whether you-re using 22520-22525 correctly. Vertebroplasty and ky... Read more
Coding Quiz Answers:
Have Vertebroplasty, Kyphoplasty Coding Down Pat? Find Out
Tip: The word "balloon" will direct you to this procedure every time. Did you conquer t... Read more
These Services Are not Part of the Global Surgical Package
If you-re not reporting them, you-re losing money. It can be hard to keep track of wh... Read more
Reader Questions:
Applying Mod 78? Don't Expect Full Reimbursement
Question: I-ve noticed that when we report procedures with modifier 78, the payer will r... Read more
Reader Questions:
Rely on E/M Code for Suture Removal
Question: A patient went out of state for surgery (a 90-day global procedure) and came b... Read more
Reader Questions:
EVD Coding Depends on Circumstances
Question: Our neurosurgeon performed an external ventricular drain (EVD) placement. Whic... Read more
Reader Questions:
Decompression Claim? Cancel Out Mod 50
Question: An established patient with lumbar stenosis reports to the surgeon. After a le... Read more
Reader Questions:
Insurers May Balk at Paying Multiple Units of 77002
Question: When we perform multiple injections at the same time, can we report 77002 (7... Read more
Reader Questions:
Apply This Code for Endoscopic-to-Open Surgery
Question: Our surgeon attempted to remove a pituitary tumor using the endoscope (62165).... Read more
Reader Questions:
Look to 95951 for Epilepsy Monitoring
Question: What is the most accurate diagnosis for epilepsy monitoring that lasts 13 hour... Read more
You Be the Coder:
Post-Traumatic Headache Means This Dx Range
Question: What are the best diagnosis codes for an acute post-traumatic headache and a c... Read more
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