Neurosurgery Coding Alert

Along with important new codes to identify services previously reported with "unlisted procedure" or imprecise substitute codes, CPT 2003 modifications serve to clarify or slightly alter already-established coding principles. Descriptor Update for Injection Codes Fresh from revision in 2002, several injection codes in the 20550-20605 range undergo additional changes for 2003. Foremost, the descriptor for 20550* eliminates the reference to ganglion cyst, now reading, "Injection(s); tendon sheath, ligament." Similarly, descriptors for 20600* (Arthrocentesis, aspiration and/or injection; small joint or bursa [e.g., fingers, toes]) and 20605* ( intermediate joint or bursa [e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa]) drop all mention of ganglion cysts. To compensate for this, CPT has created a new code, 20612 (Aspiration and/or injection of ganglion cyst[s] any location), to describe aspiration or injection of ganglion cyst at any location. Text accompanying the new code directs physicians, "To report multiple ganglion cyst aspirations/injections, use 20612 and append modifier '-59' [Distinct procedural service]," which indicates that you may report the code per injection rather than per site or muscle group, as has been true in the past. Along similar lines, descriptors for 20552 (Injection[s]; single or multiple trigger point[s], one or two muscle[s]) and 20553 (... single or multiple trigger point[s], three or more muscles) now specify "muscle(s)" rather than "muscle group(s)."

"The word 'group(s)' was removed from 20552 and 20553 because there was a great deal of confusion regarding what constituted a muscle group, and different payers were interpreting it differently," says Alison Waxler, practice management policy analyst at the American Academy of Physical Medicine and Rehabilitation in Chicago. In practice, you should continue to use the codes as before, she continues. "One or more injections in one or two muscles should be coded with one unit of 20552, while one or more injections in three or more muscles should be coded with one unit of 20553." You may report only a single unit of 20552/20553 per session, advises CPT Changes 2003, regardless of the number of injections or muscles targeted. Text Revises Instructions for Spinal Codes CPT has revised the instructional text accompanying the codes in the "Spine (Vertebral Column)" portion (22100-22855) to reflect new surgery guidelines. Specifically, previous versions of CPT have instructed, "Do not append modifier '-62' [Two surgeons] to spinal instrumentation codes 22840-22855." For 2003, these instructions have changed, stating, "Do not append modifier '-62' to spinal instrumentation codes 22840-22848 and 22850-22852." This means that two surgeons may work (and bill) as co-surgeons during reinsertion of spinal fixation device (22849) or removal of anterior instrumentation (22855) as long as they work together as primary surgeons. Craniectomy/Craniotomy Procedures Added CPT 2003 includes a few new craniectomy/craniotomy codes. The first of these, +61316 [...]