CPT®2012 Update: Tips Help You Ace Bone Biopsies With Vertebroplasties   (January 2012)

Locate the levels for primary procedure and biopsy. Read in the procedure note if your surgeon did a bone biopsy when doing the vertebroplasty. If the vertebroplasty and biopsy are at the same level, you will not report any additional bone biopsy codes. Look at examples below to strengthen your vertebroplasty reporting. Mark the Change in Code Descriptor(s) The CPT® codes for vertebroplasty have a revision in the code descriptors which clearly specifies that you [...]

ICD-10 Update: Expect to Expand Your Coding Options for Non-meningitic Complications of Herpes Zoster   (January 2012)

Report the myelopathy, ganglionitis, neuropathy, and unspecified neurological complications.You may be faced with a situation where the neurological complication after an episode of herpes zoster may involve a nerve, a ganglion, or a segment of the spinal cord. And you may encounter patients with localized numbness and even conditions like a hemiplegia. Read on to know what changes you can expect when reporting postherpetic neurological complications in ICD-10. Code 053.1x for other nervous system complications [...]

Coding Tips: 5 Major Add-On Codes Can Ease Your Cranial Procedures Coding   (January 2012)

Never ignore the add-on procedure in a craniotomy.When reporting cranial procedures, you typically only need to consider one principal component: the craniotomy. Since cranial procedures are often complex, you may very often need to report additional procedures and techniques. Read on to know the add-on codes you can frequently report for your neurosurgery billing. Report Microdissection Only Once Per SessionWhen your surgeon uses the operating microscope, you report the microdissection code +69990 (Microsurgical techniques, requiring [...]

You Be the Coder: Count Incisions and Not Aneurysms   (January 2012)

Question: Can we code for two aneurysms when they are approached through the same incision? Our surgeon performed the following procedures:1. Right frontotemporal sphenoidal craniotomy 2. Anterior skull base approach with modified orbitofrontal craniotomy 3. Microdissection and use of operating microscope 4. Microsurgical clipping of ruptured A1-A2-Acomm junction aneurysm of complex morphology with deliberate proximal temporary artery occlusion (2 minutes) 5. Microsurgical clipping of unruptured anterior communicating artery aneurysm of complex morphology 6. Intraoperative ventriculostomy [...]

Reader Question: Can You Report De-Rotation of Spine?   (January 2012)

Question: What CPT® code do we use for “de-rotation of spine” done at the time of posterior arthrodesis for scoliosis?Alaska SubscriberAnswer: The process of changing the orientation of the spine with manipulation of spinal instrumentation (i.e. rotating a rod within the screw heads or hooks attached to the spine) is considered incidental to the placement of the spinal instrumentation and is not separately reportable.

Reader Question: Report Technique and Anastomosis for Moyamoya   (January 2012)

Question: What CPT® code would be appropriate for frontal craniotomy for synangiosis when the diagnosis is moyamoya?Alabama SubscriberAnswer: There are two types of synangiosis performed for moyamoya disease. One can perform an encephaloduroateriorsynangiosis (EDAS) in which a superficial temporal artery is secured adjacent to the cortical surface or an encephalomyosynagnosis (EMS) in which temporalis muscle is secured to the cortical surface. Both procedures would be reported with the unlisted code 64999 (Unlisted procedure, nervous system). [...]

Reader Question: Count Lumbar Levels in Laminectomy   (January 2012)

Question: How do we report when the surgeon does a lumbar laminectomy with facetectomy/foraminotomy? The operative note reads as under:1. Decompressive lumbar laminectomy L2, L3, L4 complete, partial L1, L5.2. Facetectomy/Foraminotomy L2-L3, L3-L4, L4-L5 and upper L5-S1 bilateral .New York SubscriberAnswer: The description provided is not consistent, since the laminectomy that was reportedly performed was only partial at L5, while the facetectomy/foraminotomy is reported at L5-S1. If an S1 foraminotomy with medial L5-S1 facetectomy was [...]

Coding Tips: 5 Tips Build Accuracy In Your Nerve Conduction Studies Reporting   (December 2011)

Best practice: Look for the functional component and keep a close count on the nerve(s) treated. When coding nerve conduction studies, you may be faced with denials if you aren’t reporting the code(s) for every unit of service in the nerve conduction study (NCS). Take a look at the guidance below to stay on the right path to full reimbursement. 1. Look for the Sensory or Motor Component When coding for nerve conduction, first look [...]

2012 Coding Update: Revamp Your Arthrodesis Coding With These 2012 Changes   (December 2011)

Know the bundling and learn the descriptor changes. You’ll need to rethink how you’re reporting your surgeon’s arthrodesis services this year, thanks to combined codes and language changes in CPT®. Read on for advice on applying these updates and steer clear of denials for these spinal procedures. Apply These 3 Bundling Issues CPT® 2012 identifies the bundling of the codes 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar [with lateral transverse technique, when performed]) [...]

Coding Guidelines: You Are Mistaken If You Think All ICD-9 Codes Expand Into Multiple Options.   (December 2011)

Report both acute and chronic conditions that your patient has.The ICD-10-CM manual seems voluminous. You may be operating under the assumption that ICD-9 codes will always multiply into more specific options. However, that isn’t always the case. Conditions requiring two more ICD-9 codes right now might be simplified into a single ICD-10 option in 2013. Let us look for examples from a variety of disease conditions that your patient is likely to be having. Best [...]