Neurosurgical Coding
Spine
ACDF/Corpectomy
·
For ACDF- dictate a phrase that quantifies the decompression (63075)
greater than what is needed for the fusion (22554).
o
Microdissection (69990) is included – generally cannot code with
63075
o
Put highest paying code first depending on payor
o
Generally only use graft harvest (2093x) once, even for multiple
levels (controversial)
o
RVUs higher for PEEK cage (11) than for structural allograft (3).
May also be able to bill multiple levels with cage.
·
For Corpectomy (63081) - Document 50% body removal for cervical
and 30% for lumbar/thoracic
o
Corpectomy include adjacent segment discectomies (63075)
o
Special codes are used if corpectomy is for intraspinal lesion
(63300-63308)
o
Can use microdissection (69990)
Lumbar
Laminectomy/Discectomy
·
63030 vs 63047
o
May add -50 (bilateral) modifier with 63030
·
Dictate
o
May add -50 (bilateral) modifier with 63030
o
Dictate “nerve roots decompressed)
·
Laminectomy with facetecomy & foraminotomy (FF) should be
coded based on the decompressed interspace; not the bone level
o
For example, a L3-4-5 Lam with a L2-3, 3-4, 4-5, and 5-S1
decompression is a 4 level decompression and would be billed as a 63047, 63048,
63048-59 (2)
·
Laminectomy for removal of synovial cyst should be coded as
extradural lesion (ie 63267), sent to path. ICD9 may require soft tissue or
bone mass instead of “cyst of synovium”
·
Posterior Fusions are coded per disc level and there are two
separate procedures for the lateral fusion and the interbody fusion. (with a 51 modifier)
o
If you also decompress the nerve root, more than what is needed
for bone graft placement, you can add 63047-51 as well.
·
PLIF (22630) includes decompression (63012, 63030, 63047)
·
Removal and reinsertion of hardware at same level, fusion is
included
o
Use code for “failure of fusion” 733.82
o
May or may not be able to use exploration of fusion (22830) with
removal of instrumentation (22850-5)
o
For removal and insertion at different level, add instrumentation
code and fusion code for that level.
·
Spine fractures treated with a brace, unless you assist with brace
application (22315= 19.13 RVU) should be followed using EM codes – not CPT - to
avoid 90 day global.
o
For ORIF, bill the instrumentation, fusion and implants as well as
the ORIF code.
·
May bill separately for flouroscopy, +- with a separate report,
except for Kyphoplasty.
·
CSF leak repair (i.e. 63707) only for planned dural leaks, not iatrogenic
or indicental durotomies
·
“Anterior” lumbar instrumentation defined by instrumentation in
vertebral body
·
Dynamic stabilization 510k approved – not FDA approved – must be
used as adjunct to fusion
·
BMP is equivalent to morselized allograft – no RVU (20930). Only
FDA approved use is in LT cage.
Cranial
·
Remember that ventricular catheritization (61210 +- 59 if done
through separate burr hole), lumbar drains, and gliadel wafers (61517) are
extra codes.
·
For bilateral craniotomies use -59 modifier, not -50. For example,
SDH.
·
Brachytherapy has a tracking code; will need prior approval.
Others say use 61770.
·
Duraplasty can be used if you use a source from another incision
·
Cranioplasty can be used if you document bone destruction.
·
Microdissection included with ACD and Transsphenoidal (61548)
o
Put microdissection code after primary code
·
Cortical stimulation: generally surgeon cannot bill (neurologist
can) – used
·
Navigation: document preop preparation and use
·
Skull fractures: if EDH present code for that and add cranioplasty
versus elevation of skull fracture. (?)
·
Decompressive craniectomy with hematoma removal: can use either
hematoma removal (61312) +- -22 modifier or decompressive craniectomy (61322)
·
Foreign body/GSW (61570) vs GSW with debridement (61571)
·
For abscesses: document
whether it is in the brain or superficial.
·
Skull base codes designed for 2 surgeons – approach and definitive
– each paid at 100%. Generally equals primary code for 1 surgeon (100% on 1st
and 50% on 2nd with -51)
o
Debatable whether “Secondary repair for CSF leak” codes can be
used at initial surgery
·
Complex Aneurysm: include documentation of size >15mm,
calcified neck, incorporation of normal vessels, requiring temporary occlusion
or bypass.
o
If it requires carotid exposure in the neck use 35701.
o
May not pay more than simple aneurysms
·
Complex AVM’s: document size, depth, eloquent areas, need for
embolization, multiple vessels.
·
Seizure surgery: surgeon cannot bill for EEG interpretation
·
Craniotomy for biopsy miscellaneous/unknown lesion: use
exploratory craniotomy (61304)
·
Chiari decompression (61343) includes cervical laminectomies and
dural graft
·
Ommaya reservoir: generally use 61210 (not 61215)
·
Programmable Shunts: initial programming is generally included;
subsequent reprogramming is coded 62252
·
Shunt externalization: use distal revision (62230)
·
SRS (61793) is reported per lesion, even if more than one session
– up to 5 lesions.
o
If multiple lesions use the -59 modifier or -22 modifier for very
complex lesions.
o
Debatable whether one can code separately for each isocenter
o
Surgeon must be on-site and available – for his part (? – frame
placement and planning)
General
·
Spinal
fusions and adult craniotomy are the best DRGs for the hospitals
·
Per
AANS coding course, typical neurosurgeon brings in $4 to $5+ million revenue
annually for the hospital
Revised:
1/24/07
Text
Copyright 2006