Neurosurgery Coding Alert

Reviewed May 26, 2015 You'll no longer have to rely solely on 10180

You can begin using several new CPT®codes, including two for incision and drainage procedures, one for intracranial angioplasty, and three vasospasm procedure codes. Our experts explain how the new codes will allow you to more accurately report the procedures your neurosurgeon performs.   22010, 22015 Better Represent I&D Procedures   CPT®2006 adds two codes for incision and drainage procedures: 22010 (Incision and drainage, open, of deep abscess [subfascial], posterior spine; cervical, thoracic, or cervicothoracic) and 22015 (... lumbar, sacral, or lumbosacral).
 
 In 2005 the only code youhad to use for a post-operative incision and drainage (I&D) procedure was 10180 (Incision and drainage, complex, postoperative wound infection). For a non-postoperative I&D procedure, you would use 10061 (Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; complicated or multiple). For example, if the neurosurgeon must re-open and drain a patient's wound due to a post-laminectomy infection, you would report code 10180.

The descriptor for 10180 specifies ‘complex.’ You’ve been forced, however, to use 10180 for both complex spinal I&D procedures and relatively simple ones that may not even be near nerve roots. You may have tried appending modifier 22 (Unusual procedural services) to 10180, but even that was not a perfect solution.

With the two new codes, you’ll be able to differentiate the complexity and class of the I&D procedures your neurosurgeon performs. “I think it's great that there are new I&D codes for the back to allow physicians the opportunity to capture appropriate revenues for care of postoperative and/or post-traumatic wounds,” says Nancy L. Reading, RN, BS, CEO of CedarEdge Medical in Draper, Utah.

Caution: Remember to append modifier 78 (Return to the operating room for a related procedure during the postoperative procedure) to either 22010 or 22015 when your neurosurgeon performs the I&D procedure post-operatively during the global surgical period of another procedure. This shows the carrier that the I&D procedure was related to the original surgical procedure that your neurosurgeon performed.

Be sure that you assign an appropriate ICD-9 code for the postoperative wound infection as well, Reading says. Use the appropriate ICD-10 code once that code set is implemented.   Intracranial Angioplasty Codes Mirror Coronary Procedure   If your neurosurgeon performs balloon angioplasties, a specialized interventional radiological procedure, you’ll have a new code to report the procedure: 61630 (Balloon angioplasty, intracranial [e.g., atherosclerotic stenosis], percutaneous). Another new code that some neurosurgeons will want to start using is 61635 (Transcatheter placement of intravascular stent[s], intracranial [e.g., atherosclerotic stenosis], including balloon [...]