Neurosurgery Coding Alert

HCFA has released Program Memorandum No. B-01-28, dated April 19, 2001, outlining the supervision rules for more than 700 diagnostic tests. The memo, effective July 1, 2001, assigns specific levels of physician supervision required for neurosurgical diagnostic tests payable under the Medicare physician fee schedule. The levels include general, direct and personal supervision. The delay in implementation is intended to allow technicians and ancillary staff time to acquire any necessary certification to perform those services without supervision.

Note: A list of common neurosurgical diagnostic testing codes and their new supervision requirement levels can be found in the noted memorandum, Section 410.32 of the Code of Federal Regulations. They include testing of programmable pumps; diagnostic radiology of head, spine and pelvis; and nuclear medicine of nervous system.

Defining Supervision Levels

The following are definitions for the new levels of physician supervision for diagnostic tests. The procedures must be performed under:

1 = the general supervision of a neurosurgeon, which means the procedure is furnished under the neurosurgeons overall direction and control, but the neurosurgeons presence is not required during the procedure. The training of the nonphysician personnel who performs the diagnostic procedure and the maintenance of the necessary equipment and supplies is the continuing responsibility of the neurosurgeon. For example, a radiological examination of the cervical portion of the spine with two or three views could be performed at this level. This would be coded as 72040 for two or three views.

2 = the direct supervision of a neurosurgeon in the office setting, which means a neurosurgeon must be present in the office suite and immediately available to furnish assistance and direction throughout the procedure. It does not mean that a neurosurgeon must be present in the room. For example, electronic analysis of a programmable pump without reprogramming would be performed with a neurosurgeon available in the office suite. This would be coded as 62367.

3 = The personal supervision of the neurosurgeon, which means the neurosurgeon must be in the room during the performance of the procedure. For example, a diskography performed on the lumbar section of the spine would require the physical presence of a neurosurgeon in the room. This would be coded as 72295.

Note: The full text of the guidelines can be found at www.hcfa.gov/pubforms/transmit/B0128.pdf.