Neurosurgery Coding Alert

If you think neurosurgeons can only report a single code (61770) for patients undergoing stereotactic brachytherapy, think again. In most cases, the surgeon plays an integral part in the planning process, consulting with the patient and radiation oncologist extensively prior to surgery, and therefore may report additional services accordingly.

Don't Undervalue E/M Services
 
The initial physician/patient consultation is an important part of any surgical procedure. To determine the applicability of brachytherapy, for instance, the surgeon  will likely spend a lot of time on a consultation with the patient, says Lucia Zamorano, MD, professor of neurological surgery and radiation oncology, department of neurosurgery, Hunter Hospital in Detroit.

"This is the time a physician would spend with the patient prior to deciding whether or not to treat a brain tumor with brachytherapy," Zamorano says (because of restrictions due to tumor size and location, only 25-40 percent of patients are eligible to receive such treatment). The consultation encompasses elements outlined in medical or surgical evaluation and management (E/M) service codes.

Some payers routinely attempt to downcode high-level E/M services, and physicians may also code E/M services conservatively. With proper documentation, however, there is no reason you cannot claim (and receive payment for) a level-five service for brachytherapy patients. In particular, these patients may require extensive counseling encompassing 50 percent or more of the visit. For example, if you spend over 40 minutes of a typical 80-minute visit as described by 99245 (Office consultation for a new or established patient ...), you may use time as the determining factor when choosing an E/M level as long as you have documented start and stop times and the total time spent in counseling. You will want to note the information the surgeon discussed with the patient, such as test results and treatment options.

When you report any consultation code, you must be sure that the patient record includes a request for a consultation from a referring physician (this should be a written record; simply noting that a verbal request was given is not adequate), a stated reason for the request (for example, "To examine the patient for potential brachytherapy treatment"), and a written report of the consulting physician's findings to the requesting physician, says Anita L. Carter, LPN, CPC, an instructor at A+ Medical Management and Education, a school for billing and coding in Absecon, N.J. By providing this information, you verify for the payer that you have chosen the reported E/M service type and level correctly. Be sure to monitor your payment for these visits carefully and challenge the payer's decision if it downcodes the service without proper justification.

Planning Involves the Surgeon, Too

Surgeons are important members of the decision-making team that plans the patient's treatment, and they [...]