The Neurosurgery Coding Coach 2010 Archives

March 4, 2010

Question:

The vendor representative told us to use 11981 (Insertion, non-biodegradable drug delivery implant) with a 59 modifier when we place a catheter for postoperative pain management at the time of a spine procedure.  We have some insurance carriers that pay this but many don’t. Do you have any suggestions on how I can get this paid?

Answer:

No, I don’t.  And, I don’t think you are going to like my answer.  Refer to the May 1999 CPT Assistant on page 8. In summary it says pain management services may be billed by someone other than the physician performing the surgical services. Furthermore, the physician specialty societies (e.g., AAOS, AANS, ACS) say the placement of pain management devices for control of postoperative pain is included in the global surgical package for the primary surgeon and not separately billable.

Remember, just because you got paid on an incorrectly coded claim doesn't make it right.  Placement of this or any other activity to facilitate postop pain management is not separately billable for the surgeon.  Payor rules may allow reimbursement just as you've noted. But again the coding rules override the fact that the code you billed made it through the payor's edits.

February 18, 2010

Inpatient Consultations

Question:

Our surgeon was asked to see a patient in consultation from the neurology service to rule out a fracture after the patient fell ambulating in the hall.  The surgeon evaluated the patient up but never went to surgery as a fracture was ruled out, thus no global period.  We billed an inpatient consultation at that time.  Now the patient has been re-admitted to the hospital six weeks later and the internal medicine doctor has consulted our surgeon again because the patient is complaining of low back and hip pain.  Can we report an inpatient consultation code again?  

Answer:

Yes, you will report 9925x again as the consultation codes are per hospital stay.  Remember consultations have different rules than new patients and as long as all the requirements for a consultation are met, the 9925x codes may be reported one time per hospital stay.

Don’t forget that effective 1/1/10, Medicare will no longer pay for inpatient or outpatient/office (9924x) consultations. For more information on Medicare’s policy, refer to Transmittal 1875, as well as the corresponding MedLearn Matters article.

February 4, 2010

Question:

My question is this: My neurosurgeon did a thoracic partial hemilaminectomy and foraminotomy for a ruptured disc at T10-11. There are codes for cervical and lumbar discectomy (63020, 63030) but not thoracic. How should we code this?

Answer:

There is no code for this procedure so it would be appropriate to use an unlisted code, 64999.

January 21, 2010

Question:

What’s the deal – I heard the consultation codes have been deleted in 2010!  How can they do this?

Answer:

Hold on….the consultation codes have not been deleted.  These codes (9924x for office or other outpatient consultations and 9925x for inpatient consultations) still exist in CPT.  Here’s what has changed: Medicare, as a payer, has chosen not to reimburse providers for the consultation codes in 2010.  The vast majority of other payers have not stopped paying for consultation codes in 2010. Typically they will notify you if they are going to change their policy. For example, United Healthcare released the following statement:

For UnitedHealthcare commercial plans, there will be no change in reimbursement for CPT codes 99241-99245 and 99251-99255 at this time.  Physicians may continue to submit claims for these services, and will be reimbursed according to UnitedHealthcare payment policies. 

"For UnitedHealthcare Medicare Solutions, including SecureHorizons®, AARP® MedicareComplete®, Evercare®, and AmeriChoice® Medicare Advantage benefit plans, these plans will follow CMS regulations and implement the change, effective January 1, 2010. The change also includes the revalued relative-value units (RVUs) for E&M CPT codes and a new coding edit, consistent with CMS, to deny the CPT consult code as a non-covered service."

For AmeriChoice Medicaid plans that follow Medicare rules for their fee schedules, AmeriChoice will be aligning with CMS rules and implemented the change effective January 1, 2010.  For all other Medicaid states, AmeriChoice will follow the UnitedHealthcare commercial position and continue to pay for the consult codes, until directed otherwise by a state to pursue other strategies.

For more information on Medicare’s policy, refer to Transmittal 1875, as well as the corresponding MedLearn Matters article.

If you have questions or would like to speak to Kim about how this affects your practice, please contact Robin Delgatto at KZA (rdelgatto@karenzupko.com or 312.642.5616), and he will be happy to share with you KZA’s fees for this service.

January 7, 2010

Question:

What is the code for removing an interbody device from the spine? I asked this question on an internet coding discussion board and someone said to use 22850 (Removal of posterior nonsegmental instrumentation (eg, Harrington rod).

Answer:

It is not accurate to report a removal of posterior instrumentation code such as 22850 for removing an intervertebral device.  There is no stand-alone CPT code for removing an intervertebral device as there is for removing posterior and anterior instrumentation. There is not even an add-one code for this activity.  What code can you use?  Removing an intervertebral device (e.g., cage, allograft) is included in the exploration of fusion code (22830) when that procedure is also performed. 

If you’d like additional help with these codes, please contact our office and Robin Trevino will be happy to set up a contract for you to speak to Kim or Teri.