Neurosurgery Coding Alert

New procedures and techniques are constantly being added to the neurosurgery field. Although patients and providers often welcome these advances, finding a code that represents adequate reimbursement for the provider and is accepted by the carrier may be another story. One such example is spinal endoscopy, a procedure that does not have a CPT code assigned to it yet. Neurosurgery providers should be able to receive reimbursement by choosing from several coding options, establishing medical necessity and working with local carriers to file their preferred codes.

Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C., reports that coders who are tempted to stick with the familiar open code, because it seems to describe the procedure better, are in danger of upcoding. An open procedure always pays more than its comparable endoscopic counterpart. This is because an open procedure requires the patient to be cut open and sewn back up, while an endoscopic procedure is performed through a small hole. It is a less invasive procedure for the patient.

Coding Spinal Endoscopies

Neurosurgery coders should consider using these codes and modifiers, but check with the local carrier for its preference:

62263 percutaneous lysis of epidural adhesions using solution injection (e.g., hypertonic saline, enzyme) or mechanical means (e.g., spring-wound catheter) including radiologic localization (includes contrast when administered). This code includes fluoroscopic guidance and epidural injection components.

Modifier -22 unusual procedural services. Modifier -22 is used when there is no code to describe the services provided, and the services are over and above what is normally required to complete the procedure, says Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services, a coding and reimbursement consulting firm based in Denver. (The RACZ, or epidurolysis procedure, is used to dissolve some of the scar tissue from around entrapped nerves in the epidural space of the spine, so medications such as cortisone can reach the affected area.) The modifier would be used in addition to a primary code such as 62263.

72275 epidurography, radiological supervision and interpretation. This code may be considered for interpretation of the procedure when the provider dictates a formal radiological supervision and interpretation report and makes it part of the patients record. Insurance carriers may allow this code to be used in addition to code 62263.

Modifier -26 professional component. Use this modifier as applicable in conjunction with 72275 if someone other than the performing physician owns the equipment.

63030 laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar (including open or endoscopically assisted approach). This code can be used when a laminotomy (hemilaminectomy) is performed either open or endoscopically.

64999 unlisted [...]