Tag Archives: neurosurgery

2 Tips Lead to Modifier 22 Success Every Time

Posted on 15. Apr, 2010 by .

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Watch frequency and provide documentation to rationalize extra pay.

Applying modifier 22 (Increased procedural services) can help increase reimbursement if your neurosurgeon documents a greater-than-usual effort during a surgical service. To ensure your claims’ success, surgeons and coders must also exert a special effort outside of the operating room — especially in terms of documentation.

1. Apply 22 Sparingly

Payers won’t accept a modifier 22 claim unless you can provide convincing evidence that the service or procedure was truly “out of the ordinary” and significantly more difficult or time-consuming than usual.

Here’s why:

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Neurosugery Coding: 3 Easy Steps Distinguish Between 61790 & 61791

Posted on 01. Nov, 2009 by .

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Anatomy know-how points you in the right direction every time.

How do you tell the difference between 61790 (Creation of lesion by stereotactic method, percutaneous, by neurolytic agent [e.g., alcohol, thermal, electrical, radiofrequency]; gasserian ganglion) and 61791 (… trigeminal medullary tract)?

That’s the question a Neurosurgery Coding Alert reader posed when she wrote, “What is the difference between the gasserian ganglion and trigeminal medullary tract, and how do you determine which code to use?” The answer lies in knowing your anatomy so you can assign codes accordingly.

1. Know Your Nerve Anatomy

Understanding the nerve branches and how they relate to each other is your first step in distinguishing between 61790 and 61791. Here’s what you need to know:

• The trigeminal nerve provides sensation to the face. It’s the fifth (and largest) cranial nerve, also called the fifth nerve (or “V.”)

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Skull Biopsy, No Burr Hole: 61500 or 61563?

Posted on 01. Oct, 2009 by .

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Question: Our surgeon biopsied a lesion from the skull, but did not perform a craniectomy or create a burr hole for the procedure; he made an incision over the lesion and obtained the biopsy. How should I code this?

Answer: Your best option is 61500 (Craniectomy; with excision of tumor or other bone lesion of skull) though some coders might lean toward 61563 (Excision, intra and extracranial, benign tumor of cranial bone [e.g., fibrous dysplasia]; without optic nerve decompression). 61563 isn’t your best choice because there is no description of an intracranial component.

AUDIO: Neurosurgery Coding Boosters: Brain Tumor Excision vs. Hematoma Evacuation. With Dr. Greg Przybylski, Wednesday, October 7.

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Spinal Surgery Coding Challenge: Tethered Cord Release & Dural Tag Removal

Posted on 14. Aug, 2009 by .

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Question: My neurosurgeon released a tethered cord under the microscope, then excised a dural tag and sent it to pathology. Can we be reimbursed for both services, or are they inclusive?

Answer: The procedure removes adhesions (tags) from the dura to correct any neurological deficits. Physicians often remove a specimen to send for lab review, but that service is included in the primary procedure.

In this situation, you’ll report 63200 (Laminectomy, with release of tethered spinal cord, lumbar) for the cord release and +69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) for the microscope use. Don’t report the dural tag removal separately, as it is incidental to the tethered cord release.

Audio Training Event: Spinal Surgery Coding Secrets, with Dr. Greg Przybylski.

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ICD-9 2010: More Coding Options for Brain Injury

Posted on 12. Aug, 2009 by .

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Check out V80.01 and V80.09 for special screenings.

The newest edition of ICD-9 changes goes into effect Oct. 1, so adjust your system to reflect some new diagnosis codes for special neurological screenings — and one that’s about to become invalid — to be sure your claims stay on par.

Extend ‘Other Conditions’ Dx From 348.8 to 348.89

Diagnosis 348.8 (Other conditions of brain) will be invalid starting Oct. 1, but ICD-9 2010 introduces a new fifth-digit replacement: 348.89. The descriptor remains the same, so you’ll be able to use it for the same circumstances as 348.8.

“I seldom used 348.8 because I do mostly surgery coding and use the final pathology report for diagnoses,” says Kathryn Gemmell, RHIT, in the physician coding department of Luke’s Hospital in Bethlehem, Pa. “Something like calcium deposits on the brain or brain death could be coded to 348.89.” You might also turn to 348.89 to show a…

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Answers To Your Hospital Admission, Subsequent Care Coding Questions

Posted on 08. Jun, 2009 by .

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Revenue Booster: Here’s when you can claim a consult rather than an admit/subsequent care code.

Did you know if your neurosurgeon manages the patient’s head injury while another physician takes care of everything else, then you should hold off on reporting an admission service? Insurers are eager to audit hospital admission codes (99221-99223), as well as subsequent care codes (99231-99233). So you should learn all you need to know to correctly code co-management situations.

These 4 hospital admission coding FAQs help you stay out of auditors’ crosshairs.

1. What Does Hospital Admission Entail?

You may report a hospital admission (99221-99223) for a neurosurgeon (or any other specialist) as long as the neurosurgeon assumes full responsibility for the patient’s care, says Dianne Wilkinson, RHIT, compliance officer and quality manager with MedSouth Healthcare in Dyersburg, Tenn.

Example: From the emergency department the neurosurgeon admits a patient with head

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Neurosurgery Shunt Coding Chart

Posted on 18. May, 2009 by .

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Tip: You can report +62160 if your MD documents using a neuroendoscope.

Before selecting a code for initial shunt placement, you should read your neurosurgeon’s documentation to determine the locations of both the proximal (beginning) and terminal (drain site) portions of the shunt. Let this chart be your guarantee you’ll never making a shunt coding misstep in the future.

Please click here for chart.

Notes:

*The -atrial, -auricular, and -jugular shunts require your neurosurgeon to also place a venous catheter, which payers bundle into the primary procedure (62190 or 62220).

**If your neurosurgeon uses a neuroendoscope during 62225/62230, you can report +62160 (Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage [List separately in addition to code for primary procedure]) in addition to the primary procedure.

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The Neurosurgery Coding Mistake That’s Costing You $220 Per Claim

Posted on 07. May, 2009 by .

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5 Simple Steps Shore Up Your Shunting Placement, Revision, and Replacement Claims

You may know that you shouldn’t separately report a venous catheter when your neurosurgeon creates an -atrial, -auricular, and -jugular shunt, but did you realize using a neuroendoscope means including an add-on code that can boost your bottom line by $108?

AUDIO EXTRA: Where you’re losing money on spinal co-surgeries, with Lynn Anderanin.

Follow these 5 steps to highlight what’s most important in your neurosurgeon’s documentation and avoid leaving well-deserved money on the table.

Step 1: Pinpoint Where the Shunt Begins, Ends

Don’t be too eager to assume your initial shunt placement code. “With the volume of work we all have, it’s easy to become complacent and fall into the habit of billing the same code each time you see the word ‘shunt,’” says Beth Thomsen, billing coordinator for the Department of Surgery

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Take Our Multi-Level Spinal Surgery Coding Challenge

Posted on 07. Apr, 2009 by .

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AUDIO TRAINING EVENT: Receive Optimum Reimbursement for Spinal Co-Surgeries, with Lynn Anderanin.

Multiple procedures on different spinal levels during the same session not only mean multiple codes but modifiers, too. Make the grade on your next spinal surgery claim by breaking down the following procedure.

Scenario: During a single session, your neurosurgeon performed the following procedures:

• L4-L5 Diskectomy

• L5-S1 Diskectomy

• L4-L5 Transforaminal interbody fusion using posterior interbody technique

• L5-S1 Transforaminal interbody fusion using posterior interbody technique

• Bone graft placement (autograft)

• L4-L5 Interbody cage placement

• L5-S1 Cage placement

• L4, L5, S1 Bilateral pedicle screw instrumentation.

Find Your Solution Piece by Piece

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Watch Your Back: Bust These 5 Spinal Instrumentation Myths

Posted on 20. Feb, 2009 by .

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Same-session arthrodesis errors? Read on to discover where you might be going wrong.

Myth #1: When coding instrumentation, you need to know the type of device before anything else.

Reality: When you choose CPT codes for instrumentation, location — rather than the type of device — is the most important selection criterion. “I would first look at the approach: anterior versus posterior,” confirms Rebecca Woodward, CPC, coding representative for MedVentures, LLC in High Point, N.C.

Instrumentation may be described as anterior (attaching to the front portion of the spine or vertebral segment, toward the “center” of the body) or posterior (attaching to the back of the spine or vertebral segment, facing toward the back), and can consist of rods, cages, plates, wires, and/or other mechanical devices, says Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Lawrenceville, Ga.

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