The Neurosurgery Coding Coach 2008 Archives

Question:

How do we bill for the CyberKnife?

Answer: 

Neurosurgeons use CPT 61793 (Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator), one or more sessions) to report their involvement in the procedure.  The code includes placing the headframe as well as the neurosurgeon’s participation in planning the procedure and removal of the headframe.  It is not appropriate to separately bill for headframe placement (e.g., 20660) or stereotactic navigation (e.g., 61795) as these activities are included in 61793.  Use 61793 to report the same level of neurosurgeon participation if using a Gamma Knife or linear accelerator. 

Question:

What is the best code for the subcutaneous placement of a bone flap in the abdominal region after craniectomy surgery?  My surgeon said he is placing the bone flap in the abdomen for storage.  I’m thinking about using the abdominal exploration code 49000 (Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure).  What do you recommend?

Answer: 

Use +61316 (Incision and subcutaneous placement of cranial bone graft.  List separately in addition to code for primary procedure) for this activity.  Notice that +61316 is an add-on code and is not reported alone.  You’ll want to report +61316 with the primary procedure as directed by CPT using 61304, 61312, 61313, 61322, 61323, 61340, 61570, 61572, 61680-61705. 

Question: 

Can I bill for the repair of the cranial dura if the tumor being resected has invaded the dura?

Answer: 

Repair of the cranial dura is included in the surgical craniotomy code and is not separately reported.  If, however, you must harvest graft material through a separate skin incision (e.g., fascia lata) then you may also report the appropriate graft code (e.g., 20920).

Co-Surgery: Who Bills What?

Question:

We just reviewed the documentation audit report you recently completed for us – thanks so much!  It was really helpful and educational.  One question: how do we code a transphenoidal hypophysectomy when we do the procedure with an ENT surgeon?  The ENT doctor says he has his own codes to bill. 

Answer: 

Thank you – it was a pleasure to help you and your practice.

There are two codes to report this procedure.  First, CPT 61548 (Hypophysectomy or excision of pituitary tumor, transnasal or transseptal approach, nonstereotactic) may be reported if the procedure is performed via an open approach through the nose or septum.

Alternatively, 62165 may be reported (Neuroendoscopy, intracranial;   Neuroendoscopy, intracranial;with excision of pituitary tumor, transnasal or trans-sphenoidal approach) if the procedure is performed using an endoscope.

Each surgeon reports the same CPT code, 61548 or 62165) appended with modifier 62 (Two Surgeons), also called the co-surgery modifier.

You can expect to be paid 62.5% of the payor’s allowable as a co-surgeon.

CMS 1500 Claim Rejection for Incomplete Data

Question:

We recently began receiving rejections from Medicare because we did not have an entry in Box 11 on the CMS 1500 claim form.  Medicare is telling us we must put NONE in the box if there is no primary Insurance.  This has never happened before.

Answer:

We researched this question and found the following instructions in the Medicare Manual.  The Medicare instructions state that if the patient does not have any primary insurance to Medicare, the word “none” must be entered in box 11.  Here is the excerpt form the Claims Submission Instruction section related to the question.

Item 11 -THIS ITEM MUST BE COMPLETED, IT IS A REQUIRED FIELD. BY COMPLETING THIS ITEM, THE PHYSICIAN/SUPPLIER ACKNOWLEDGES HAVING MADE A GOOD FAITH EFFORT TO DETERMINE WHETHER MEDICARE IS THE PRIMARY OR SECONDARY PAYER. If there is insurance primary to Medicare, enter the insured's policy or group number and proceed to items 11a - 11c. Items 4, 6, and 7 must also be completed. NOTE: Enter the appropriate information in item 11c if insurance primary to Medicare is indicated in item 11. If there is no insurance primary to Medicare, enter the word “NONE” and proceed to item 12.

We believe that although the policy existed before, it was not enforced as zealously as CMS wanted.  Your recent denials are likely due to this fact.

Question:

How do we code a transphenoidal hypophysectomy when we do the procedure with an ENT doctor?  The ENT doctor says he has his own codes to bill. 

Answer:

There are two codes to report this procedure.  First, CPT 61548 (Hypophysectomy or excision of pituitary tumor, transnasal or transseptal approach, nonstereotactic) may be reported if the procedure is performed via an open approach through the nose or septum.

Alternatively, 62165 may be reported (Neuroendoscopy, intracranial;   Neuroendoscopy, intracranial; with excision of pituitary tumor, transnasal or trans-sphenoidal approach) if the procedure is performed using an endoscope.

Each surgeon reports the same CPT code, 61548 or 62165) appended with modifier 62 (Two Surgeons), also called the co-surgery modifier.