Category: CC-Neurosurgery

Intraoperative Angiography
Post

Intraoperative Angiography

December 30, 2021 Question: If my neurosurgeon does an intraoperative angiogram after she has clipped an aneurysm, at the same operative session, can we bill for both the clipping and angio? Answer: Good question – yes, both procedures can be reported if your neurosurgeon does the catheterizations for the angio (36222-36226). However, if another physician...

Drilling the Internal Auditory Canal
Post

Drilling the Internal Auditory Canal

December 16, 2021 Question: If I do a retrosigmoid craniotomy for resection of an acoustic neuroma (61520) but I also drill the internal auditory canal for exposure to the tumor, can I code separately for that using 69960 (Decompression internal auditory canal)? Answer: The craniotomy code, 61520, includes doing whatever exposure/approach is necessary in order...

Intraoperative Ultrasound
Post

Intraoperative Ultrasound

December 2, 2021 Question: I see there is a code for intraoperative ultrasound, 76998. Can I code that when I use ultrasound intraoperatively to assist with tumor removal? Answer: No – intraoperative ultrasound is included in the tumor removal surgical CPT code and should not be separately reported by the surgeon. *This response is based...

Pedicle Screw Augmentation
Post

Pedicle Screw Augmentation

November 11, 2021 Question: What do we code when we put cement around the pedicle screws, or inject cement into the pedicle screw tract, for augmentation due to osteoporosis or failed back syndrome? Can we code a vertebroplasty? Answer: Augmentation of pedicle screws is included in the instrumentation codes (e.g., +22840-+22844) and not separately reported...

Application of the Multiple Procedure Payment Reduction in Anterior-Posterior Spine Procedures
Post

Application of the Multiple Procedure Payment Reduction in Anterior-Posterior Spine Procedures

October 28, 2021 Question: Does the multiple procedure payment reduction apply for the same day anterior-posterior procedures when done through separate incisions? For example, if 22558 (anterior lumbar interbody fusion) and 22612 (posterolateral lumbar fusion) are performed, there is separate positioning and separate incisions so I don’t think the modifier 51 reduction should apply. Answer:...

Postop Pain Control
Post

Postop Pain Control

October 14, 2021 Question: I’m placing catheters in the erector spinae plane through a separate puncture after the surgical wound is closed.  We are billing 64463 [Paravertebral block (PVB) (paraspinous block), thoracic; continuous infusion by catheter (includes imaging guidance, when performed] but it’s not always being paid.  Please help. Answer: Actually, ensuring management of the...

Ventricular Drain Postop Tumor Resection
Post

Ventricular Drain Postop Tumor Resection

September 30, 2021 Question: Do I use a modifier 58 (staged procedure) on the ventricular drain code when it’s done in the ICU after a craniotomy for tumor? Answer: That is probably not the correct modifier though we’d need more information about why the ventricular drain was placed. Typically, in this scenario, the ventricular drain...

Counting Problems Addressed for Medical Decision Making
Post

Counting Problems Addressed for Medical Decision Making

September 16, 2021 Question: If a patient has one stable chronic illness and one acute uncomplicated illness without systemic symptoms, can we “up” the level of Problems Addressed to Moderate? Answer: No, sorry, unfortunately it doesn’t work that way.  The problems are not additive or cumulative.  One stable chronic illness and one acute uncomplicated illness...

Harvest of Pericranial Graft
Post

Harvest of Pericranial Graft

September 2, 2021 Question: Can we code separately for harvesting pericranial graft, such as temporalis fascia, when doing a craniotomy? Answer: CPT guidelines generally allow coding for harvest of graft material when it is obtained through a separate skin incision. In your scenario, the graft material is being obtained through the same surgical exposure and not via...

Sign up for KZAlertsSign up for KZAlerts

Coding Coaches