February 18, 2021 Question: We have an MRI in house which has made me confused about how to count the data for the neurosurgeon’s E/M code. Please help. Answer: Good question and let’s simplify things. The AMA specifically states there should be “no incentive”, related to E/M coding, to the physician for ordering tests. So...
Category: Neurosurgery
New 2021 E/M Coding Guidelines
February 4, 2021 Question: In the new guidelines, how does Time affect billing for a teaching physician’s E/M service when the resident spends a great deal of time with the patient? Answer: Good question! Only the time of teaching physician would “count” in the scenario you describe. The new guidelines say that the time of...
Documenting Family History for New Patient Visits
January 21, 2021 Question: I’ve heard that all you need to document for family history is the word “none”, and that would count as documenting. Is this enough? Answer: No. Documenting “none” is saying that the patient does not have a family history, and this would not be accurate as we all have a family...
Stent and Embolization Coil Used in Same Session
December 17, 2020 Question: The surgeon used a stent and then inserted an embolization coil for an aneurysm. Are both billable? Answer: If the stent is placed to provide a latticework for deployment of the embolism coil, then no. You would just bill for the embolization. If the stent itself is the sole definitive procedure...
Removal of CP Angle Meningioma
December 3, 2020 Question: What’s the best way to code a retrosigmoid approach and removal of a meningioma at the cerebellopontine angle? Should I use 61519 or 61520? Answer: CPT 61520 (Craniectomy for excision of brain tumor, infratentorial or posterior fossa; cerebellopontine angle tumor) is more accurate since it better describes the location of the...
New 2021 Evaluation and Management Code Guidelines
November 12, 2020 Question: I heard that the E/M code guidelines are changing in 2021. Will this apply to all E/M codes? Answer: Good question. The 2021 changes will NOT apply to all E/M codes. The 2021 changes apply only to the new patient, 9920x, and established patient, 9921x, categories of codes. That means you...
ICP Monitor and EVD Placed on Both Sides
October 29, 2020 Question: We placed an ICP monitor on the left side of the cranium and a right ventriculostomy, both using the twist drill. We know to use CPT 61107 but wondered about using modifier 50 (bilateral procedure). Thoughts? Answer: Medicare does not recognize modifier 50 on 61107, though some payors might or may...
Elective Cranioplasty after Emergent Hemicraniectomy
October 15, 2020 Question: I did an emergency craniectomy on a stroke patient 4 months ago. It is now time to reconstruct the defect and I’ll be doing that by placing some mesh and screws with Methyl methacrylate. Should I be using the 62140/62141 code series? Answer: Actually, CPT considers what you are doing to...
Post-Op Anterior Cervical Wound Abscess
October 1, 2020 Question: How do I code for repair of wound dehiscence with deep abscess status post ACDF (anterior cervical discectomy, decompression and fusion)? I looked at 22010 but that’s for a posterior procedure. Answer: Take a look at 21501 (Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax) to...
New 2021 E/M Coding Guidelines
September 17, 2020 Question: I just signed up for your 2021 E/M webinar – I’m so excited! Will these changes apply to inpatient codes too? Answer: Great – I look forward seeing you! At this time, the changes are only for new patient and established patient codes – office services. Learn more from Kim Pollock...