Neurosurgery Coding Alert

You'll soon be able to report E/M services with stereotactic radiosurgery

The latest National Correct Coding Initiative (NCCI) edits, version 11.3, which went into effect Oct. 1, include deletions of some bundles that neurosurgery coders deal with and some additions that will be important to your nerve block coding. You Can Start Reporting Consultations With 61793 The NCCI edits that will affect most neurosurgery coders are the deletions of bundles that include E/M services as part of 61793 (Stereotactic radiosurgery [particle beam, gamma ray or linear accelerator], one or more sessions). Version 11.3 deletes 58 bundles between 61793 and E/M service codes, such as 99201-99205 and 99211-99215. After Oct. 1, when these edits went into effect, you can begin reporting both the E/M service your neurosurgeon performs and the stereotactic radiosurgery for the same patient on the same day, as long as the documentation supports submitting the codes.

Many neurosurgery coders have had trouble getting reimbursement for all of the physician's services because of these bundled E/M services. Many neurosurgeons perform a full evaluation and high-level consultation with a patient before performing a stereotactic radiosurgery. When NCCI bundled E/M codes with 61793, you couldn't report those services separate from the surgery.

Many neurosurgery encounters are initial services, which often take place in a hospital setting. Payers often deny the E/M service, even when modifier 57 (Decision for surgery) is attached, says Rena Hall, CPC, coder for the Kansas City Neurosurgery Group in Missouri. -The fact that the surgeon may actually get reimbursement for initial encounters with surgical candidates is a step in the right direction. The new edits will definitely lessen the work load we have been experiencing fighting to get proper payment on those claims.-

Example:  A physician requests that your neurosurgeon determine whether a hospitalized patient has a brain tumor. Your surgeon makes his evaluation based on exam, history and available tests performed. The neurosurgeon then recommends stereotactic radiosurgery for later that day. Once the NCCI 11.3 edits go into effect, you-ll be able to report both the E/M code (e.g., 99241-99245) for the consultation and the surgical code (61793).

Typically, because of scheduling conflicts or the need for preoperative testing, a physician rarely performs stereotactic radiosurgery on the same day as the initial evaluation, so it is likely that the bundling edit was designed to prevent billing for cursory pre-op examinations on the day of surgery, coding experts say. Because global surgical package guidelines cover the E/M codes, however, the NCCI edits were duplicative.

Caution: To report an E/M service on the day of surgery, you could append modifier 57 to an E/M service code such as 99201-99205, which informs the insurer that your physician made a decision to perform [...]