Category: CC-Neurosurgery

VP Shunt Reprogramming
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VP Shunt Reprogramming

December 5, 2019 Question: We had a patient show up in our office, after an MRI ordered by another physician, and wanted their shunt settings checked. We checked the shunt and reprogrammed the shunt to the appropriate settings. We’ve never seen this patient before. Would we bill both the consultation code and the shunt reprogramming...

Shunt Revision
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Shunt Revision

November 14, 2019 Question: I had to replace the ventricular catheter and the valve on a patient with a VP shunt.  What code should I use? Answer: Actually you get two codes!  CPT 62225 is used for the ventricular catheter replacement and 62230 for the valve replacement.  Both codes are appropriate in this scenario. *This...

Augmentation of Pedicle Screws
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Augmentation of Pedicle Screws

October 31, 2019 Question: I injected cement into the pedicles to augment screws in a patient with osteoporosis. My coder suggested using +22859 (Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (List separately in addition to code for primary...

T9-11 Epidural Tumor Removal
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T9-11 Epidural Tumor Removal

October 17, 2019 Question: I did bilateral laminectomies at T9, T10, T11 and removed an epidural tumor. I billed 63276-50, 63276-50-59 and 63276-50-59 but got paid for only 63276-50. Should I have used modifier XS (separate site) instead of 59? Answer: CPT 63276 (Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, thoracic) involves removal of the...

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...

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