Neurosurgery practices once again face a series of new codes, reimbursement rules, and practice regulations that must be implemented. Although attending the professional development courses sponsored by the American Association of Neurological Surgeons (AANS) remains a very effective means of conveying both the old and new rules of coding and reimbursement, attendees frequently ask for additional resources that might serve as a reference when questions arise during the year. Consequently, this edition of the Coding Corner will focus upon the publications and other resources available to assist in addressing coding and billing questions.
CPT 2003 Is Available
The American Medical Association (AMA), which owns the copyrights to Current Procedural Terminology (CPT), remains an invaluable source of both written and computer-based manuals to assist the physician in practice. It is imperative that the office has the newest version of CPT (the CPT 2003 book already is available). This is the definitive source for identifying appropriate codes to describe physician services and includes several categories of new codes applicable to neurosurgery, including endoscopic cranial codes, several trauma codes for craniectomy and lobectomy, as well as a code for placement of chemotherapeutic wafers into a tumor bed. However, it is also important to maintain copies of previous CPT editions. Certain third-party payers may base payment policy on previous versions of CPT, whereas others may take several months before recognizing new codes. The AMA has a Web site, https://www.amapress.com, which provides a wealth of publications that are essential to running an effective practice.
Another valuable text from the AMA is Medicare RBRVS: The Physician’s Guide. This manual summarizes in user-friendly format the modifier rules applicable to individual codes as well as the relative value units ascribed to each code by the Centers for Medicare and Medicaid Services (CMS). When dealing with payers whose fee schedules follow the relative-value system of CMS, billing personnel should know the comparative values of code sets done in the same operative setting so that the primary stand-alone code used to describe the service is also the highest-valued code.
With changes to the practice expense formula over the past four years, certain codes have changed in their comparative values. Although the relative-value measures also can be obtained from the Federal Register in its early November publication (https://www.access.gpo.gov), the concerns of Thomas A. Scully, CMS administrator, about the anesthesia formula have postponed publication until recently. Moreover, the Federal Register is a more cumbersome document compared to the AMA publication.
CodeManager Offers Integrated Format
Alternatively, the CodeManager offered by the AMA on CD-ROM combines CPT 2003 Professional Edition, International Classification of Diseases, 9th Clinical Modification (ICD-9-CM 2003), Healthcare Common Procedure Coding System (HCPCS 2003), relative-value unit data, Medicare payment rules, and the National Correct Coding Initiative (CCI) rules in one integrated format. Moreover, the software references the CPT Assistant publications and will communicate with the CPT Assistant Archives software to help coders and billers understand the AMA interpretation of various coding rules and controversies.
Specialty societies also provide more specific guidelines to coding. The AANS publishes A Guide to Coding Procedures for Neurosurgery, now in its second edition. Similarly, the North American Spine Society (NASS) publishes Common Coding Scenarios for Comprehensive Spine Care that shows a multitude of coding examples for both open and percutaneous procedures. The latter book also can be purchased through the AMA. Although there are a variety of newsletters that also offer coding and reimbursement advice, practices should be careful about the accuracy of recommendations given by vendors and others in the absence of appropriate review by experts involved in the CPT or Relative-value Update Committee (RUC) process.
Finally, specific coding questions can be referred through the AANS Coding Hotline, NASS, or directly through the AMA.
In summary, there are a variety of coding and reimbursement resources available to facilitate the efficiency and accuracy of the coding and billing process. I highly recommend participating in the AANS-sponsored courses held around the country eight times per year to efficiently obtain a foundation of knowledge about the rules and processes. This will facilitate the use and interpretation of the other resources to effectively manage a practice.
Gregory J. Przybylski, MD, is director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center, and professor of neurosurgery at Seton Hall University. He is a faculty member for AANS-sponsored coding and reimbursement courses.
ONLINE CODING RESOURCES
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