Essential Neurosurgical Coding

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AANS Neurosurgeon
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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.

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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

Past Tips
  • 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? 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. 
  • What would be the correct CPT codes for removal of discitis? 63030 or 63267? Answer: if the patient has an epidural abscess or phlegmon, make sure to code for that: 63267
     

  • How do we avoid non-payment for 22845 with 22853? Answer: you have to append a -59 modifier on 22845, since it is considered bundled into 22853 and 22854. Find out more:

    John Ratliff, MD, FAANS

  • When would it be acceptable to use modifier 22 without being red flagged with the insurers? Answer: You can use -22 but your documentation must clearly support the substantial additional work and the reason for the additional work 
  • Coding for intraop data review and electrophysiology? Answer: The surgeon does not code for intraoperative SSEP, EMG or other neuromonitoring  
  • Two surgeons, how do you bill? 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 handbook for more details: 
  • 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

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