Neurosurgery Coding Alert

Question: A neurosurgeon sees a patient in the emergency department. He admits the patient, who has head trauma and requires ICP monitoring. The catheter insertion is not the major service for this patients care: Much time was taken, and documentation supports an extensive history and physical, exam and medical decision-making. May we report 99223 for the admission and 61107 with modifier -25?

Washington, D.C., Subscriber
 
Answer: Yes, you may charge for both the admit (99223, initial hospital care, per day, for the evaluation and management of a patient) and the intracranial pressure  monitoring (61107, twist drill hole for subdural or ventricular puncture; for implanting ventricular catheter or pressure recording device). Because 61107 is a minor procedure (10-day global period), append modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) rather than -57 (decision for surgery) to the E/M code. Dont use these modifiers with 61107 or any other procedure codes (the descriptors say evaluation and management service). In this case, no modifier is needed with 61107.