AANS Neurosurgeon | Volume 28, Number 4, 2019

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Essential Neurosurgical Coding

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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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@AANS #RealCodingQuestion I am doing a lateral interbody fusion and then percutaneously placing a spinous process plate to provide posterior stabilization. How do I code for posterior spinous process plating or for interspinous decompression devices when I am also doing a fusion?

#AANSCodingCourse Answer: Report any decompression or arthrodesis codes that may apply to the procedure. Spinous process plating does not count as posterior instrumentation so do not use 22840 or 22842. Would recommend using 22899 (unlisted instrumentation code).

#RealCodingquestion
  • How do I code a lateral/direct lateral/extreme lateral interbody fusion? 
    Answer: Anterior interbody arthrodesis codes (22558, 22585 for addition levels) should be used for these procedures if the path to the disc space is retroperitoneal. Do not use lateral extracavitary codes. @AANSNeuro #neurosurgery #coding #medicalcoding #AANSCodingCourse

  • How should I code an interbody fusion with implant that has attached screws (e.g. stand-alone ALIF cage with integral screw fixation)?
    Answer: For intervertebral body cage with attached plate and/or screws that insert through cage into vertebral body and NOT a separate, biomechanically distinct device, use 22853 alone. Do not separately report 22845.

  • How do I code for repair of a C6-7 fracture/dislocation?
    Answer: In addition to the arthrodesis and instrumentation codes that would apply, the use of the open reduction and internal fixation code (22325 for lumbar, 22326 for cervical, 22327 for thoracic) may be used. Do not additionally report a decompression code (such as laminectomy code) at the level of the ORIF procedure.

  • How should spinal fusions autograft, allograft be billed (CPT)?
    Answer: For spinal fusions, there are several options for bone grafting codes. If bone material from another source (e.g. cadaver) is used, the an allograft code (20930 or 20931) is used. If the patient’s own bone is used, this is autograft (20936, 20937, 20938, 20939). If the autograft is harvested from same incision, use 20936. If bone is harvested from another site (e.g. iliac crest) through a separate fascial incision, then use 20937 or 20938. If only bone marrow is aspirated from another site, use 20939.

  • 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.

  • 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:

  • 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?
    Answer: 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?
    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.

  • If a rehab facility I have privileges at consults me for a postop patient in postop global, can I bill for the consult?
    Answer: No the global period extends across facilities or practice settings.

  • Can you bill for treatment of vasospam, 61650 when also treating the same vascular territory you are doing a coiling?
    Answer: If vasospasm is a separate and pre-existing condition then yes, if vasospasm arose during coiling, then no.

  • What ICD-10 code is used when documentation states hydrocephalus following Interventricular Hemorrhage?
    Answer: G91.4 

  • Why do some companies pay 69990 with 63030 and some don’t? What is the recourse if some don’t?
    Answer: CPT guidelines allow for reporting of +69990 but 63030 is not one of the codes where CMS reimburses +69990.

  • 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.

 

Calendar/Courses

Bypass 2020 – Anniversary Symposium
Jan. 8-10, 2020; Switzerland Frauenklinikstrass, Switzerland

Sun Valley Stroke Conference 2020
Jan. 9-12, 2020; Sun Valley, Idaho

Kranzler Chicago Review Course in Neurosurgery
Jan. 24-31, 2020; Chicago

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