Neurosurgery Coding Alert

Question: How would the following surgery be coded? The operative note reads: Transoral needle biopsy of C2 under fluoroscopic guidance. Description of procedure: Under general endotracheal anesthesia, the exposure was performed by a doctors assistant to arrive to the posterior pharynx. Under fluoroscopic guidance, a biopsy needle was advanced approximately five times into the dens. Specimens were obtained and sent for pathology and the needle was withdrawn.

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Answer: Because the dens is a part of the cervical vertebra (upper spinal column, not spinal cord),the accurate coding is 20225 (biopsy, bone, trocar, or needle; deep [vertebral body, femur]) with modifier -22 (unusual procedural services). Modifier -62 (two surgeons) or modifier -80 (assistant surgeon) could apply to doctors assistant. Code 20225 reimburses at a lesser rate than 61575 (transoral approach to skull base, brain stem or upper spinal cord for biopsy, decompression or excision of lesion), but because code 61575 is for an open skull base approach, not a needle bone biopsy, it is incorrect in this case. The use of modifier -22 should allow for additional reimbursement, especially if you have indicated the longer comparative time documented in the operative report.