Neurosurgery Coding Alert

CMS, along with the National Technical Information Service (NTIS), has released version 8.3 of the national Correct Coding Initiative (CCI) for the fourth quarter of 2002 (Oct. 1-Dec. 31). This latest CCI with nearly 55,000 code-pair revisions encompasses the largest number of changes since version 6.3 in 2000. Unlike past CCI revisions, in which the greatest number of changes were concentrated on bundling anesthesia and E/M services to more extensive procedures, version 8.3 focuses on surgical and injection procedures, including many relevant to neurosurgical practice. Mutually Exclusive Revisions The category that CCI defines as "mutually exclusive" (procedures not generally reported together due to the impossibility or improbability of performing them during the same session) contains few edits of interest for neurosurgeons. Among them, craniectomy 61501 and stereotaxis codes 61720, 61790 and 61791 are newly classified as mutually exclusive of HCPCS codes G0242 and G0243, which describe multi-source photon stereotactic radiosurgery. In this case, CCI lists the CPT codes as "category 1" codes, i.e., those codes that will be recognized if practices report them with a second, mutually exclusive procedure. Therefore, for example, if you report 61720 and G0243 together, the payer will acknowledge 61720 only. Note: The G codes are for facility charges only. Craniectomy/craniotomy codes 61304-61333, 61440-61530, 61563-61564 and 61862, as well as stereotaxis procedure 61735, are also now mutually exclusive of G0242/G0243, but in this case CCI gives the HCPCS codes, rather than the CPT codes, the category 1 designation, e.g., if 61862 and G0242 are mistakenly reported together, only the latter will recognized. With the exception of the 61862/G0242-G0243 code pair, all of the above edits include a "1" status indicator, meaning the edit pairs can be circumvented if the procedures are performed at separate anatomic sites and if an appropriate modifier (e.g., modifier -59, Distinct procedural service) has been appended to the category 2 code. CCI 8.3 contains no deletions in the mutually exclusive pair edits. Comprehensive/Component Edits Are Comprehensive, Indeed The familiar comprehensive/component edit pairs, in which a "lesser" service is bundled to or included in a more inclusive service, undergo significant revision in version 8.3. Specifically, as standards of care evolve, CCI continues to adapt by disallowing separate payment for injection and imaging services that routinely accompany many procedures. For example, injection 20526 (Injection, therapeutic [e.g., local anesthetic; corticosteroid], carpal tunnel) bundles a host of less-extensive injection codes, including 62318, 62319, 64415, 64417, 64470, 64475, as well as use of operating microscope 69990. Similarly, injection codes 20550-20553 include 62318 and 62319, with 20551-20553 also now including 69990. Codes to describe application and removal of instrumentation for stereotaxis, 20660-20690, also bundle 62318, 62319, 64415, 64417, 64470 and 64475, plus 64450. Furthermore, excision procedures 22210-22214 are [...]