Essential Neurosurgical Coding
Twice a month, AANS Neurosurgeon’s Code Red brings neurosurgeons tips for coding various procedures. Check back often for new tips and follow us on Twitter @AANSNeurosurg to receive Code Red in real time.
How would you code for an L3 vertebrectomy with discectomy and decompression via an anterior approach? Answer: To code for a lumbar corpectomy, you have to document removal of at least 1/3 of the vertebral body. Otherwise you only code for the fusion, 22558. There is no anterior lumbar decompression code.
John Ratliff, MD, FAANS
- What ICD 10 code is used for hydrocephalus following interventricular hemorrhage? Answer: G91.9
- When is it appropriate to use code 63012? A: Only when the pre-operative diagnosis is a spondylolisthesis and the procedure involved remove of abnormal facets and/or the pars interarticularis (Gill procedure)
- Can a provider can receive credit for a L4 laminectomy and a L4/5 discetomy?
#AANSCodeRed A: only one code can be reported at each interspace, so either the laminectomy or the discectomy, not both. Pick the code base on the pre-op diagnosis. http://bit.ly/2KwxVvS
- What would be the correct CPT codes for removal of discitis? 63030 or 63267?
#AANSCodeRed Answer: if the patient has an epidural abscess or phlegmon, make sure to code for that: 63267 #RealCodingQuestion
How do we avoid non-payment for 22845 with 22853?
#AANSCodeRed Answer: you have to append a -59 modifier on 22845, since it is considered bundled into 22853 and 22854. Find out more: http://bit.ly/2KwxVvS
John Ratliff, MD, FAANS
- When would it be acceptable to use modifier 22 without being red flagged with the insurers?
#AANSCodeRed Answer: You can use -22 but your documentation must clearly support the substantial additional work and the reason for the additional work http://bit.ly/2KwxVvS
- Coding for intraop data review and electrophysiology?
#AANSCodeRed Answer: The surgeon does not code for intraoperative SSEP, EMG or other neuromonitoring #RealCodingQuestion
- Two surgeons, how do you bill?
#AANSCodeRed A: Depends on the procedure and the roles and specialties of the surgeons. A -62 modifier can be used in surgeons of different specialties. See page 112-114 of the #AANSCodingCourse handbook for more details: http://bit.ly/2KwxVvS.
- When is it okay to un-bundle 61107 from the craniotomy/ craniectomy? #AANSCodeRed Answer: Placing a monitor via a separate incision can be coded separately but the need for and use of a separate and distinct skin incision has to be documented @AANS #RealCodingQuestion
- If a rehab facility I have privileges at consults me for a postop patient in postop global, can I bill for the consult? #AANSCodeRed Answer: No the global period extends across facilities or practice settings @AANS #RealCodingQuestion
- Can you bill for treatment of vasospam, 61650 when also treating the same vascular territory you are doing a coiling? #AANSCodeRed Answer: If vasospasm is a separate and pre-existing condition then yes, if vasospasm arose during coiling then no @AANS #RealCodingQuestion
- What ICD-10 code is used when documentation states hydrocephalus following Interventricular Hemorrhage? #AANSCodeRed Answer: G91.4 @AANS #RealCodingQuestion
- Why do some companies pay 69990 with 63030 and some don’t? What is the recourse if some don’t? #AANSCodeRed Answer: CPT guidelines allow for reporting of +69990 but 63030 is not one of the codes where CMS reimburses +69990.
Clemens M. Schirmer, MD, PhD, FAANS
There is a new ICD-10 code for spinal stenosis with claudication: M48.062. This covers both anatomy and symptomatology and thus appropriate for both E and M and surgical coding.
Jack Knightly, MD, FAANS
2019 Mayo Clinic Advancements in Surgical & Medical Management of the Spine
Jan. 13-17, 2019; Kohala Coast, Big Island, Hawaii
Pituitary Education Day
Jan. 16-18, 2019; Orlando, Fla.
Innovations in Endoscopic Minimally Invasive Brain Surgery
Jan. 16-19, 2019; Celebration, Fla.
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