Neurosurgery Coding Alert

Plus: Don't forget the new method for reporting closed skull fracture treatments

While CPT 2007 features several revisions to the coding conventions for lumbar and cervical total disc arthroplasties (see cover story), it also mandates other changes that will be relevant to neurosurgery practices, specifically when the surgeon performs electrothermal annuloplasty.

On Jan. 1, electrothermal annuloplasty moves from Category III (Temporary) to Category I (Permanent) status, says Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery. -They have parsed the electrothermal technique out of the T code and given it its own CPT code,-  Sandhusen says.

When the surgeon conducts electrothermal annuloplasty in 2007, you should:

- report 22526 (Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level) for a single level.

- report +22527 (... one or more additional levels [list separately in addition to code for primary procedure]) for each additional level.

Old way: In 2006, you would have used 0062T for the same procedure. However, that T code was revised to exclude electrothermal annuloplasty.

In 2007, you should only use 0062T (Percutaneous intradiscal annuloplasty, any method except electrothermal, unilateral or bilateral including fluoroscopic guidance; single level) if the neurosurgeon does not use electrothermal technology during the annuloplasty, Sandhusen says.

Report -Hairline- Skull Fracture Service With E/M

The CPT 2007 manual does not contain 21300 (Closed treatment of skull fracture without operation), which you used to report if your neurosurgeon treated a nondepressed (e.g., hairline) fracture of the skull. From now on, CPT wants you to code these encounters with the appropriate-level evaluation and management code. If you see the patient more than once for treatment of the skull fracture, report the proper E/M code for each visit.

This change makes sense because during treatments of most nondisplaced skull fractures, the surgeon checks for neurological damage but performs no surgery, Sandhusen says. An E/M code better represents this service than a surgical procedure code would. The E/M service would probably be level four or level five for treatment of a closed skull fracture.

Suppose your neurosurgeon treats a new patient who  fell off a horse, suffered a head injury and lost consciousness for five minutes. Your neurosurgeon provides level-four E/M service and finds a closed fracture of the patient's parietal bone but no further trauma.

On the claim, you should:

- report 99204 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a comprehensive history; a comprehensive examination; medical decision- making of moderate complexity) for the E/M.

- attach ICD-9 code 800.02 (Fracture of vault of skull; closed without mention of intracranial injury; with brief [less than one hour] loss of consciousness) to 99204 to represent the patient's head injury.

- attach ICD-9 code E828.2 (Accident involving animal being ridden; rider of animal) to 99204 to represent the cause of the patient's injury.

CPT Breaks Magnetic Stimulation Treatment Into 2 Codes

Next year, when your neurosurgeon performs transcranial magnetic stimulation treatment planning and delivery, you should use these codes:

- 0160T (Therapeutic repetitive transcranial magnetic stimulation treatment planning) for planning.

- 0161T (Therapeutic repetitive transcranial magnetic stimulation treatment delivery and management, per session) for treatment delivery.

Old way: In 2006, you reported magnetic stimulation sessions with 0018T (Delivery of high power, focal magnetic pulses for direct stimulation to cortical neurons), but this code no longer exists. Now, the service is divided into separate codes for planning and delivery of this stimulation to make reporting it more specific.