Neurosurgery Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Our surgeon performed an extensive cervical corpectomy and fusion. The patient returned for several postoperative visits and recently had the halo screws changed. We ordered the screws, and the surgeon replaced them in the office. The screws cost $163. Is this a billable service even though the patient is still in the post-op phase?

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 Answer: There is no specific HCPCS code for halo screws. Therefore, the best code choice is the miscellaneous CPT supply code 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]). To ensure sufficient reimbursement, include a photocopy of the invoice for the screws with your claim.
 
In addition, there should be documentation to justify the medical necessity of changing the screws. In other words, be sure to explain what happened to the previous screws and/or why it was necessary to replace them: Did they loosen? Was there contamination? Were they stripped and unusable? Without an explanation as to why the change was necessary, the payer may reject the claim.