Neurosurgery Coding Alert

Question: A 73-year-old patient presents to the emergency department (ED) with a severe, sudden onset headache, light sensitivity, confusion, and severe nausea and vomiting. The ED physician performs a physical and neurologic examination, and orders labs. Seeing signs of a possible hemorrhage, the ED physician consults with the neurosurgeon, who begins directing the patient’s care. The surgeon orders a noncontrast CT of the head and a CT angiography.

The CT of the head reveals an acute diffuse subarachnoid hemorrhage and blood within the basal cisterns. The CT angiography reveals a 7 mm ruptured saccular aneurysm. Upon review of these results, the neurosurgeon determines that the patient needs a craniotomy and clipping of the ruptured anterior communicating artery aneurysm. The neurosurgeon performs a complex intracranial aneurysm repair. They also submit imaging reports for the CTs.

What CPT^® codes can I report for the neurosurgeon’s work?

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Answer: The ED physician will report the evaluation and management (E/M) service, as they handled the patient’s initial care; the neurosurgeon’s first patient care actions were ordering the CTs.

Therefore, you’ll submit the following codes for the neurosurgeon’s work:

• 61697 (Surgery of complex intracranial aneurysm, intracranial approach; carotid circulation) for the surgery
• 70450 (Computed tomography, head or brain; without contrast material) for the CT of the head
• 70496 (Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing) for the CT angiography
• Append modifier 26 (Professional component) to 70450 and 70496 to show you are only coding for the interpretation and report of the CTs

ICD-10-CM coding: Submit I60.2 (Nontraumatic subarachnoid hemorrhage from anterior communicating artery) appended to 61697, 70450, and 70496.

Gabbi Gifford, CPC, CDEO, CPMA, CRC, CVBA, Contributing Writer