Category: CC-Neurosurgery

Artificial Cervical Disc Placement
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Artificial Cervical Disc Placement

October 3, 2019 Question: We are just starting to do these procedures and I want to get our coding sorted out. We will be doing a cervical discectomy with decompression under fluoroscopy and implanting the artificial disc. We think the correct codes are: 22551(anterior cervical discectomy and decompression), 22856 (total disc arthroplasty) and 76000 (fluoroscopy)....

Intraoperative Testing of the IPG
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Intraoperative Testing of the IPG

September 19, 2019 Question: Can I code 95971 for intraoperative testing of the implantable pulse generator (IPG) when the spinal cord stimulator is placed? The operative note says “intraoperative testing was performed to confirm the appropriate connections.” Answer: CPT guidelines state “test stimulation is not considered electronic analysis or programming” and “is included in the...

Multiple Laminectomies to Place a Spinal Cord Stimulator
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Multiple Laminectomies to Place a Spinal Cord Stimulator

September 5, 2019 Question: I billed 63655 (Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural) twice because I did laminectomies at T9, T10 and T11. I billed 63655 and 63655-59 but only 63655 was paid. Can you help me appeal? Answer: Actually, no we can’t help. CPT 63655 includes any number of levels of laminectomies...

Vertebral Augmentation Coding
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Vertebral Augmentation Coding

August 22, 2019 Question: Is it ever appropriate to bill 22513 with 3 units? Answer: CPT 22513 states Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic. It is used to report...

Use of a Scribe
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Use of a Scribe

August 8, 2019 Question: We are hiring a scribe for the doctor because it will help improve his documentation. Is there anything we need to know about how to document this? Answer: Yes, absolutely. This situation should be clearly delineated so a third party reviewer can identify the provider who performed the service, and the...

DBS Battery Replacement
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DBS Battery Replacement

July 25, 2019 Question: When our doctors replace a DBS generator because the battery is depleted and they reprogram at the same time, we can bill for the programming, correct? Answer: Yes, you can code for the generator replacement using 61885 (or 61886 if the two leads – right and left – are connected to...

Billing for Hospital NP/PA Consults
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Billing for Hospital NP/PA Consults

July 11, 2019 Question: I heard you speak at the recent AANS coding course – you were awesome and the course was fantastic…everyone should go.  The surgeon I work with has a question regarding billing. Some of the hospitals in the area have a Nurse Practitioner or Physician Assistant on staff that see Neurosurgery consults...

Prescription Refill Visits
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Prescription Refill Visits

June 20, 2019 Question: We get calls from patients to renew their medications.  When the patient comes to office to pick up prescription, can we bill for a nurse visit with 99211? Answer: No.  CPT makes it very clear that picking up a prescription does not constitute a billable E/M service. *This response is based...

Intraoperative Ultrasound for Tumor Removal
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Intraoperative Ultrasound for Tumor Removal

June 6, 2019 Question: My surgeon uses the intraoperative ultrasound to assist with a brain tumor removal. I am billing 76998 with modifier 26 for the professional component.  Sometimes we don’t get paid.  Should I appeal these denials? Answer: No….actually, intraoperative ultrasound is included in the global surgical package for the neurosurgeon and should not...

Coding for Platelet-Rich Plasma Injections in the Spine
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Coding for Platelet-Rich Plasma Injections in the Spine

May 23, 2019 Question: We are starting to do platelet-rich plasma injections in the spine.  Would we bill 64483?  Answer: No because 64483 is specifically for an “anesthetic agent and/or steroid” injection.  The most accurate code is 0232T (Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed).  Be sure to...

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