Neurosurgery Coding Alert

You can apply modifier 22 only in this situation.

Confidently skip reporting a twist drill, cranial burr, or trephine in addition to the neuroendoscope code to end unbundling errors.

Compare your answers to our experts and see how you fare.

Keep Things Simple for 61516

Answer 1: You would select 61516 (Craniectomy, trephination, bone flap craniotomy; for excision or fenestration of cyst, supratentorial).

Avoid This Open Procedure Code Pitfall

Answer 2: Select 62162 (Neuroendoscopy, intracranial; with fenestration or excision of colloid cyst, including placement of external ventricular catheter for drainage).

Protect yourself: You should not report the endoscopic code (62162) in addition to the open procedure code (61516). The endoscopy code does not describe an extra step above and beyond the related open procedures. Instead, you should report 62162 only to describe the endoscopic procedure.

Important exception: Know the one case in which the above rule does not hold true. When reporting +62160 (Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage [List separately in addition to code for primary procedure]) to describe endoscopic placement of a ventricular catheter, you must choose a primary procedure to accompany the endoscopic code. Code +62160 describes only the additional work of neuroendoscopic assistance, says Gregory J. Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison.

Allowable primary procedure codes for +62160 include 61107, 61210, and 62220-62230, according toCPT guidelines.

Dont Fall for the Conversion Trap

Answer 3: You should report 61548 (Hypophysectomy or excision of pituitary tumor, transnasal or transseptal approach, nonstereotactic).

Although such occurrences are rare, if the surgeon needs to convert an endoscopic procedure to an open procedure because of complications or other difficulties, you should report only the code for the successful (open) procedure, experts say.

Avert this disaster: Because the surgeon began with an endoscopic procedure, you may be tempted to report 62165 with modifier 53 (Discontinued procedure) in addition to 61548, but this is incorrect. You should report only 61548. As long as the surgeon completes the service,you should bill the successful procedure only.

Note: If the surgeon spends a long time attempting to complete an endoscopic procedure before ultimately converting to an open approach, you may be able to append modifier 22 (Increased procedural services) to account for the extra effort and to boost reimbursement, says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians and Childrens University Medical Group Compliance Program.

Often surgeons spend more time trying to perform the endoscopic procedure than it would usually take to perform the entire procedure, Bucknam says. If the surgeon decides he has to convert, he has the additionalwork of starting over. If the surgeon describes this process well, payers will often provide additional reimbursement for this additional time and work.

Solve This Endoscopy + Laminotomy Scenario

Answer 4: Dont pull your hair out looking for a special code to describe the procedure. CPT procedure code 63030 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, including open or endoscopically assisted approach; one interspace, lumbar) already includes the use of neuroendoscopic assistance. You neednt report anything in addition to 63030 to describe such a procedure.

Simplify Neuroendoscopy CCI Rules

Answer 5: No. When coding for neuroendoscopy procedures, be aware that the Correct Coding Initiative (CCI) bundles access codes such as burr hole and twist drill procedures to the endoscopy itself.

Specifically, every code in the twist drill, burr hole(s), or trephine section (61105-61253) of CPT is an inclusive component of intracranial neuroendoscopy codes 62161-62165.

And neuroendoscopy procedure 62164 is mutually exclusive of procedures 61510-61512, 61518-61521, 61526-61530, 61545, and 61575, plus skull base surgery codes 61601, 61606-61608, and 61615-61616.