Neurosurgery Coding Alert

You will see new abbreviation AOC in the 2020 CCI Policy Manual.

You learned all about the National Correct Coding Initiative (CCI) 26.0 procedure-to-procedure (PTP) edits in Neurosurgery Coding Alert vol. 21, no. 2. Along with these edits, you also have a revised CCI Policy Manual to read through. Although the revisions to this year’s manual are minor, it’s still a smart idea to know what changed from last year.

Take a look at what’s new in the CCI Policy Manual to always submit clean claims in your neurosurgery practice.

Don’t Miss AOC Abbreviation and Descriptor Capitalization

Throughout the manual, you will notice that the first letter of the code descriptors has now been capitalized. For example, the last sentence of Section three of Part F “Spine (Vertebral) Column,” now reads, “CPT^® code 22505 (Manipulation of spine requiring anesthesia, any region) shall not be reported separately.” (Emphasis added). You will see this capitalization throughout the entire manual.

The 2020 manual also uses the new abbreviation “AOC” for add-on code. You will see this revision throughout the entire manual. For example, Section 4 of Part F “Spine (Vertebral) Column now reads, “Many spinal procedures are grouped into families of codes where there are separate primary procedure codes describing the procedure at a single vertebral level in the cervical, thoracic, or lumbar region of the spine. Within some families of codes, there is an AOC for reporting the same procedure at each additional level without specification of the spinal region for the AOC.” (Emphasis added).

Note: Remember that you should never report an add-on code as the primary code for a procedure on your claims. Add-on codes are always reported with an appropriate primary code. Add-on codes are identified with the special symbol “+.”

“This is a feature of add-on codes that some people forget,” says Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey. “One cannot report an add-on code unless the valid primary code (to which the add-on code is associated with) is also reported. CPT^® lists the specific primary codes to which add-on codes may be used if that service is performed.”

Manual Adds New Modifier Options in 2020

Throughout the manual, you will see the addition of the X{EPSU} modifiers. For, example, Section 9 of Part F “Spine (Vertebral) Column, reads, “CMS payment policy does not allow separate payment for CPT^® codes 63042 (Laminotomy...; lumbar) or 63047 (Laminectomy...; lumbar) with CPT^® codes 22630 or 22633 (Arthrodesis,… lumbar) when performed at the same interspace. If the two procedures are performed at different interspaces, the two codes of an edit pair may be reported with modifier 59 or XS.”

Modifier XS (Separate structure) is one of the X{EPSU} modifiers that you may be able to use instead of modifier 59 (Distinct procedural service) to break a PTP edit, if appropriate.

Don’t miss: This passage also illustrates the capitalization of the first letter in code descriptors.

You will also see examples of these new modifier additions in Part C “Nervous System.” For example, Section 5 now reads, “If two procedures are performed at the same anatomic site and same patient encounter, one procedure may be bundled into the other (e.g., one procedure may be integral to the other). However, if the two procedures are performed at separate anatomic sites or at separate patient encounters, they may be separately reportable. Modifiers 59 or -X{ES} may be reported to indicate that the two procedures are distinct and separately reportable services under these circumstances.”

So, it is extremely important that you understand the rules for appending modifier 59 and the X-modifiers, including XE (Separate encounter) and XS. Remember that you should only use modifier 59 and other CCI-associated modifiers to bypass a CCI edit unless you meet the proper criteria for the use of the modifier. The documentation in the medical record must satisfy the criteria required by any CCI-associated modifier that you use.

Mark Down New Biopsy Instruction

Section 2 of Part C “Nervous System” will give you further advice on how to report biopsies. According to the manual, you should not report biopsies “in the course of CNS surgery” as separate procedures. For 2020, CMS added that you should, “see Chapter VIII, Section I, Subsection 10 (General Policy Statements), for further information regarding biopsies.”

When you look at the General Policy statements, you will see some information that can help you when reporting biopsies:

• If the physician performs a biopsy at the time of another more extensive procedure, like an excision, destruction, or removal, then you can separately report the biopsy, but only under specific circumstances. If the physician performs the biopsy on a separate lesion, then it would be separately reportable. In this instance, you could append modifier 58 or modifier XS. However, if the physician performed the biopsy “for the purpose of assessing margins of resection or verifying resectability,” then you cannot separately report the biopsy.
• Also, if the physician performs the biopsy and submits it for pathologic evaluation that will be completed after he performs the more extensive procedure, then you cannot separately report the biopsy with the more extensive procedure.

Why is this clarification important? Having further clarification on how to report biopsies will help you submit clean claims.