Neurosurgery Coding Alert

According to HCFA Program Memorandum B-01-09 dated Feb. 8, 2001, HCFA has temporarily suspended version 6.3 National Correct Coding Initiative (CCI) edits that bundled 66 evaluation and management (E/M) services to many neurosurgical procedural codes. The suspension is retroactive to Oct. 30, 2000, the effective date of the 6.3 edits. It also includes any edit pairs that were continued in version 7.0, effective through March 31, 2001. HCFA is reviewing the edits, and a number of them may be reimplemented no earlier than July 1, 2001.

Most significant about the 6.3 edits was the bundling of E/M services with diagnostic procedures a decision that took many physicians and coders by surprise, says Barbara Cobuzzi, CPC, CHBME, president of Cash Flow Solutions Inc. in Lakewood, N.J. The changes were not adequately publicized and placed a financial burden on doctors who were suddenly receiving denials for previously covered procedures, Cobuzzi says.

The following neurosurgery codes are a sampling of those no longer bundled with E/M services:

95970 electronic analysis of implanted neurostimulator pulse generation system

95971 ... simple brain, spinal cord, or peripheral neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming

95972 ... complex brain, spinal cord, or peripheral (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, first hour

95974 ... complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour

Neurosurgery practices are encouraged to review denials received on the inclusive codes, and to resubmit applicable claims to their carriers (they will not automatically be reprocessing). Any denied E/M services meeting the criteria of significant and separately identifiable should be resubmitted.

Note: HCFAs transmittal does not specifically require coders to append modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M service on resubmitted claims. However, most coding experts consider this practice correct coding and recommend it.