3 Complex Neurosurgery Coding Scenarios Made Simple

Posted on 9 Jul, 2019 |comments_icon 0|By Elizabeth

Profit from expert answers to these neurosurgery coding conundrums.

Neurosurgery coding may not be as challenging as, well, brain surgery — but it’s up there! Why suffer confusion and risk your bottom line when Meagan Williford, BA, MA, CPC-A, our resident neurosurgery coding expert, can help you avoid reporting errors?

Read on for straightforward guidance to select the right codes from the almost-right codes for three costly neurosurgery coding challenges.

Scenario 1: Home in on This Code for Removal of Previously Placed Spinal Catheter

What CPT® code should we report if the neurosurgeon removed a previously placed tunneled spinal catheter?

Answer: Carefully read the procedure note to confirm that the neurosurgeon removed a previously placed tunneled catheter. When the neurosurgeon removes a spinal catheter, you should report 62355 (Removal of previously implanted intrathecal or epidural catheter).

Don’t miss: This code applies to tunneled spinal catheters for long-term medication administration and not to percutaneously-placed catheters for short term bolus or continuous infusions.

Note: Code 62355 also applies to both epidural and intrathecal catheters, so you can report 62355 for removal of either an epidural or an intrathecal catheter.

Tip: Don’t forget to report the removal of the pump in addition to removal of a catheter if an internal pump was also implanted. For pump removal, report code 62365 (Removal of subcutaneous reservoir or pump, previously implanted for intrathecal or epidural infusion).

Scenario 2: Understand When to Correctly Append Modifier 24

Our surgeon completed a L5 laminectomy on a patient. Two months later, the patient presented to the emergency department (ED) with headache, neck stiffness, and fever. The surgeon who performed the laminectomy was brought in, and he completed a lumbar puncture while the patient was still in the ED. Should we append modifier 24 or 25 to the ED visit service?

Answer: Assuming the problem is unrelated to the patient’s initial surgery, you will report the ED visit and lumbar puncture, while appending the correct modifiers. Since the new symptoms might reflect meningitis, these services may be related to the original laminectomy if an incidental durotomy occurred and a subsequent infection developed.

For a separate, unrelated condition, you would first report 99282 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination, and medical decision making of low complexity …).

Modifier alert: You should append modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) to 99282 because the service was for a new problem during the laminectomy’s global period.

Don’t forget: You should only attach modifier 24 to an appropriate evaluation and management (E/M) code when the physician renders the E/M service during a 10- or 90-day postoperative global period for reasons unrelated to the patient’s original surgery.

Also, modifier 24 only applies to services your physician performs after the surgical procedure within the global period of that procedure.

Note, too, that the medical record must show the E/M visit was unrelated to the postoperative care, and the diagnosis should clearly indicate the reason for the unrelated postoperative encounter.

Code 62270: You should also report 62270 (Spinal puncture, lumbar, diagnostic) on this claim.

Modifier alert: You should append modifier 79 (Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period) to 62270 to indicate the lumbar puncture was unrelated to the original laminectomy.

You would also append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) if the decision to perform the minor procedure of the lumbar puncture was made during the E/M visit.

Scenario 3: Don’t Miss the Modifier on This Claim

In a patient with medically intractable epilepsy, the neurosurgeon replaced the pulse generator with a new one, using a new incision and pocket. According to the op note, the surgeon “used stereotactic guidance, created bilateral burr holes, and implanted electrode arrays.” He also performed a craniectomy and inserted an RNS pulse generator. He reopened the prior VNS internal pulse generator (IPG) incision and removed the old IPG and left the old electrode behind.

Which CPT® codes should we report?

Answer: Since the surgeon replaced the old generator with a new one and placed it in a separate pocket through a separate incision, you should report both 61886 (Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to 2 or more electrode arrays) and 61888 (Revision or removal of cranial neurostimulator pulse generator or receiver).

You would append modifier 59 (Distinct procedural service) to the 61888 service.

The surgeon implanted two electrode arrays through separate burr holes, so you will report 61863 (Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array) and +61864 (… without use of intraoperative microelectrode recording; each additional array (List separately in addition to primary procedure)).

Don’t miss: When the surgeon implants the first array of subcortical electrodes but does not obtain an intraoperative recording, you should report 61863. For each additional array, you should report +61864.

Caution: Keep in mind that treatment of medically-intractable epilepsy with deep brain stimulation may not be covered by insurers because of limited information on safety and efficacy for this indication.

Contributing Editor: Meagan Williford

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The Coders’ Specialty Guide 2019: Neurology/Neurosurgery includes all CPT® and HCPCS codes relevant to neurology and neurosurgery, simple descriptions that explain each code, expert advice for assigning codes, Medicare reimbursement details, diagnosis codes crosswalk, applicable modifiers, CCI edits, global days, code index, hundreds of anatomical illustrations, and more.



Elizabeth works on an array of projects at TCI, researching and writing about modern reimbursement challenges. Since joining TCI in 2017, she has also covered the nuts and bolts of cybersecurity, compliance with federal laws, and how to tap into the advantages of telehealth services.

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