Neurosurgery Coding Alert

If you've ever filed a claim using an unlisted-procedure code, you know how much effort is involved. To ensure that the surgeon's work (and the coder's work in preparing the claim) is properly rewarded, our experts offer you the following three tips. Tip 1: Describe the Procedure in Plain English Anytime you file a claim using an unlisted-procedure code (for example, 22899, Unlisted procedure, spine; or 64999, Unlisted procedure, nervous system), you must submit a full operative report to describe the procedure or service. But if you're looking for fair reimbursement, the operative notes alone won't be enough. You've got to include a separate report that explains in simple, straightforward language exactly what the surgeon did.
 
"There's no 'standard' fee for an unlisted-procedure code," says Eric Sandham, CHC, CPC, compliance manager for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno. "Insurers consider claims on a case-by-case basis and determine payment based on the documentation you provide. Unfortunately, claims reviewers, especially at lower levels, do not have a uniformly high level of medical knowledge, and surgeons don't always dictate the most accessible notes." Part of the coder's job in preparing the claim is to act as an intermediary between the surgeon and the claims reviewer, providing a description of the procedure in layman's terms.
 
"If the person making the payment decision can't understand what the physician did, there's not much chance that the reimbursement you receive will properly reflect the effort involved," says Barbara Cobuzzi, MBA, CPC, CHBME, president of Cash Flow Solutions, a physician reimbursement consulting firm in Brick, N.J. Be careful to avoid or explain medical jargon and difficult terminology. And, if appropriate, you may include diagrams or photographs to better help the insurer understand the procedure.
 
For example, CPT includes no specific code to describe open-door laminoplasty, so you should report the procedure using 64999. When describing this procedure, you should use the surgeon's operative notes as a guide, stressing the main points of the operation and why it was necessary. A sample narrative might read: Patient has spinal stenosis (723.0, Cervical), a narrowing of the spinal canal that compresses the spinal cord, which leads to pain, numbness and lost motor abilities.
 
To preserve spinal stability, the surgeon chooses "open-door" laminoplasty, rather than decompressive laminectomy, to relieve pressure on the spinal cord.
 
Following incision, the surgeon removes the tips of the spinous process (the rear-facing bony protrusion of a vertebral segment) at the affected level. He then cuts through the lamina (the bony arch surrounding the spinal cord) on one side of the spinous process and notches the lamina on the opposite side to create a "hinge." The surgeon [...]