Neurosurgery Coding Alert

Version 8.1 of the national Correct Coding Initiative (CCI) is available and remains active from April 1 to June 30, 2002. It contains no significant edit additions or deletions, but it does include several minor changes that affect neurosurgical practices. Mutually Exclusive Code Pairs CCI classifies coding edits into two categories: mutually exclusive code pairs and comprehensive/ component code pairs, explains Susan Callaway, CPC, CCS-P, an independent coding and reimbursement specialist and educator in North Augusta, S.C. Mutually exclusive procedures are those services/procedures "that cannot reasonably be done in the same session. An example of a mutually exclusive situation is when the repair of the organ can be performed by two different methods. One repair method must be chosen to repair the organ and must be reported," according to CCI. Such edits are arranged into "column 1" and "column 2" codes. Per CCI instructions, mutually exclusive codes are not "bundled" (i.e., procedures identified with column 1-codes are not included in or incidental to procedures identified with column 2-codes, or vice versa) but are not to be billed together due to conflicting CPT definitions for the two codes or the "medical impossibility/improbability that the procedures could be performed at the same session." In those cases in which codes identified as mutually exclusive are reported for the same patient encounter, generally only the lesser-valued (column 1) procedure will be recognized and reimbursed. Comprehensive/Component Code Pairs Comprehensive/component code pairs are the more familiar bundling edits, in which one procedure/service (identified as the component code) is a standard part of or incidental to a more complex or definitive procedure/service (identified as a comprehensive code) and, therefore, may not be reported or reimbursed separately. A common example in neurosurgical practice is bundling 20660 (Application of cranial tongs, caliper, or stereotactic frame, including removal [separate procedure])to 61793(Stereotactic radiosurgery [particle beam, gamma ray or linear accelerator], one or more sessions), says Stacey Lang, coding and physician reimbursement analyst at Allegheny General Hospital in Pittsburgh. Because you can't perform stereotactic radiosurgery without placing the stereotactic frame, billing separately for 20660 with 61793 would be considered unbundling which could lead to an unreimbursed claim (at best) or audits and accusations of fraudulent coding (at worst). Codes 22520 (Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic) and 22521 ( lumbar) now include +69990 (Micro-surgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]). This edit continues a trend in which use of the operating microscope is included as part of more and more neurosurgical procedures. In addition, 22521 and 22851 (Application of intervertebral biomechanical device[s] [e.g., synthetic cage(s), threaded bone dowel(s), methylmethacrylate] to vertebral defect or interspace) include anesthesia service 01905 (Anesthesia [...]