Neurosurgery Coding Alert

Remember: You should not report +99417 for any time unit less than 15 minutes.

When CPT^® 2021 becomes effective on Jan. 1, 2021, you’ll see numerous new codes, deletions, and revisions. Although you won’t gain any new neurosurgery-specific codes this year, you will get a highly anticipated new evaluation and management (E/M) code. Neurosurgery practices should especially be aware of the revised injection codes and deleted laminectomy codes.

Keep your neurosurgery claims in tip-top shape by staying on top of the following code additions, revisions, and deletions you will see next year.

Discover New Prolonged Services Code +99417

CPT^® 2021 will add new prolonged services code +99417 (Prolonged office or other outpatient evaluation and management service(s) beyond the minimum required time of the primary procedure which has been selected using total time, requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service, each 15 minutes of total time (List separately in addition to codes 99205, 99215 for office or other outpatient Evaluation and Management services)).

You should report +99417 “to report prolonged total time (ie, combined time with and without direct patient contact) provided by the physician or other qualified health care professional on the date of office or other outpatient services (ie, 99205, 99215),” according to CPT^®. However, you should only report +99417 “when the office or other outpatient service has been selected using time alone as the basis and only after the total time of the highest-level service (ie, 99205 or 99215) has been exceeded.”

For example, you’ll code an existing patient with an office visit totaling 71 minutes as 99215 and +99417 x 2. The 15-minute threshold does not have to be met to report +99417. Rather, you’ll append one unit of +99417 for a visit that falls within 55 minutes to 69 minutes, a second unit that falls within 70 minutes to 84 minutes, and so on.

Caution: You should not report +99417 for any time unit less than 15 minutes. Also, you should never report +99417 in conjunction with codes 99354, 99355, 99358, 99359, 99415, or 99416.

Don’t miss: For all other non-office/outpatient E/M code sets that may be coded based on the 1995/1997 guidelines and time estimate guidelines, you’ll continue to use the existing prolonged services code range +99354-+99357 (Prolonged service with direct patient contact).

Pinpoint Revised Injection Codes

You’ll also see several minor revisions to the following injection codes in 2021. (Emphasis added).

Revisions: 64479 (Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), cervical or thoracic, single level) and +64480 (Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), cervical or thoracic, each additional level (List separately in addition to code for primary procedure)).

These descriptors will add an “s” to “agents,” so now the codes include multiple anesthetic agents instead of just one. Additionally, the semicolon shift changes the subsequent extensions of the codes.

Don’t miss: You will also see these same revisions in codes 64483 (Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, single level) and +64484 (Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, each additional level (List separately in addition to code for primary procedure)).

Mark Down These Deleted Codes

You will say good-bye to several neurosurgery-related codes in 2021. For example, CPT^® will delete 61870 (Craniectomy for implantation of neurostimulator electrodes, cerebellar, cortical) and 62163 (Neuroendoscopy, intracranial; with retrieval of foreign body).

Additionally, you will lose laminectomy codes 63180 (Laminectomy and section of dentate ligaments, with or without dural graft, cervical; 1 or 2 segments) and 63182 (… more than 2 segments).

Finally, in 2021, you will no longer be able to report the following injection T-codes:

• 0228T (Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; single level) and +0229T (… each additional level (List separately in addition to code for primary procedure))
• 0230T (Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; single level) and +0231T (… each additional level (List separately in addition to code for primary procedure))

T-code refresher: You’ll find the T-codes section toward the back of your CPT^® book. T-codes, also called Category III Codes, are “temporary codes for emerging technology, services, procedures, and service paradigms. Category III codes allow for the collection of specific data,” according to CPT^®. Payment for these codes is not guaranteed, and you’ll need to work out the details with your payers before reporting any T-codes so you’ll know if the service is covered.