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The Neurosurgery Coding Coach 2012 Archives
| Ventriculostomy Removal |
May 3, 2012
Question:
Is there a CPT code for removing a ventriculostomy?
Answer:
No, the removal is included in the code for the placement (e.g., 61107, 61210) and not separately reported.
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| Endoscopic Dorsal Ramus Rhizotomy |
April 12, 2012
Question:
We just hired a new neurosurgeon and he is doing rhizotomies endoscopically. He says he uses a working channel in the endoscope that allows passage of a radiofrequency probe so he can see the nerves as the probe locates and ablates the medial branches of the dorsal ramus. We’ve been billing 63190-52 (Laminectomy with rhizotomy; more than 2 segments) and the reduced service modifier indicates we didn’t do the laminectomy. One of our insurance companies recently denied this after they reviewed the operative report. What should we do?
Answer:
Unfortunately there is not a CPT code that describes an endoscopic rhizotomy procedure. Remember, CPT says if there is not a code then we should use an unlisted code and not an existing code with modifier 52. Therefore, the most appropriate way to report this procedure is with 64999 (Unlisted procedure, nervous system).
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| Brain Tumor and Lobectomy |
March 29, 2012
Question:
Can I code a tumor resection (e.g., 61510) and a lobectomy (e.g., 61539) when done through the same incision?
Answer:
In these cases, you will report one code for the primary procedure performed based on the primary diagnosis. It would not be appropriate to report two craniotomy CPT codes for a procedure performed through a single craniotomy exposure.
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| Repair of Dura During Discectomy |
March 15, 2012
Question:
We are billing 63030 for a discectomy but the spine surgeon wants to also bill for repairing the dura. The operative note states an “incidental durotomy” was made. Can we also bill 63710 for the dura repair?
Answer:
No. Repair of an intraoperative complication such as this is included in the global surgical package for the primary procedure, 63030, and not be separately billed by the spine surgeon.
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| Placement of JP Drain |
March 1, 2012
Question:
I wanted to clarify whether or not we can bill for a Jackson Pratt drain that is inserted through a separate incision. Our doctors do these for almost every lumbar and cervical surgery they perform as well as their cranial surgeries. 62272 was mentioned but CPT only mentions it in relationship to drainage of CSF.
Answer:
CPT 62272 (Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter)) is not appropriate for placement of a JP drain since the drain is not placed in the spinal canal. In fact, placement of a wound management or surgical drainage device such as a JP drain or Penrose drain is not separately reported. Placement and removal of the device is included in the global surgical package for the primary procedure and not separately reported.
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| Neuroendovascular Coding |
February 16, 2012
Question:
We just hired a neuroendovascular surgeon and his cases are complicated to code! He says he did a “three vessel angiogram” so does that mean I will report 3 codes (36217 x 3)?
Answer:
Good question and, yes, the coding for these cases is complex! Rather than documenting a “three vessel angiogram” we recommend the physician document the specific vessels catheterized.That level of specificity is necessary in order to choose the correct codes. You’ll report one stand-alone code (36215 or 36216 or 36217) for the highest order of vessel catheterized in each separate vascular family. Then you will report an add-one code (36218) for additional vessels separately catheterized in each vascular family. Don’t forget that you can also report the associated radiological supervision and interpretation (S&I) codes, with modifier 26, if there is documentation of the surgeon’s radiologic interpretation.
The bottom line is that you need to know the head and neck as well as spinal vascular anatomy and how the catheterization and radiology codes relate. A great resource is KZA’s GPS for Neuroendovascular Coding!
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| Hardware Block |
January 26, 2012
Question:
Thank you for coming to our practice to provide on-site coding education for our neurosurgeons and pain management physicians – the course was fantastic and your handout is now my “Bible”!
I forgot to ask you a question: One of our pain management doctors is doing a procedure called a hardware block and I can’t seem to find the CPT code for this. Can you please help?
Answer:
Thank you for your kind words! There is no CPT code for a hardware block; therefore, we have to use an unlisted code (e.g., 64999).
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| Combined Lumbar Posterolateral and Interbody Fusion Code |
January 12, 2012
Question:
I heard there was a new lumbar fusion CPT code for 2012. Can you tell me more about it?
Answer:
Yes, as of 1/1/2012 you may no longer report 22612 and 22630 together for a procedure at the same level. There is a new combined code that we must use when you perform a posterolateral and an interbody fusion on the lumbar spine – CPT 22633. The corresponding add-on code for each additional level combined procedure is 22634. If you missed the webinar that Kim Pollock gave a few weeks ago on the subject, you can purchase it here.
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Find more Questions and Answers in the
Neurosurgery Coding Coach Archives.
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Kim Pollock,
RN, MBA, CPC
Teri Romano,
RN, MBA, CPC
Coding Resources
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