http://www.supercoder.com/forum/ Supercoder - Ask an Expert? Forum: Neurosurgery Coding - Recent Posts en Sun, 12 Feb 2012 12:13:01 +0000 http://www.supercoder.com/forum/topic/frontal-craniotomy-with-menengial-biopsy#post-11278 Wed, 08 Feb 2012 23:09:36 +0000 Ssandra Herron 11278@http://www.supercoder.com/forum/ <p>How to code: Frontal Craniotomy with Menengial Biopsy and Dural repair with a periosteal dural graft, Fibrin glue and Duragen plus sponge. Diagnosis of CNS inflammatory disease. </p> http://www.supercoder.com/forum/topic/2-different-procedures-performed#post-11220 Tue, 07 Feb 2012 06:13:07 +0000 Birendra Meher 11220@http://www.supercoder.com/forum/ <p>Modifier -59 is not applicable in this scenario. You could use -51 to 63047.<br /> 22855<br /> 63047-51 </p> http://www.supercoder.com/forum/topic/2-different-procedures-performed#post-11202 Mon, 06 Feb 2012 16:39:19 +0000 Kim Frenzel 11202@http://www.supercoder.com/forum/ <p>I have 2 different procedures that was performed in the operating room. 1st I have anterior cervical removal of the 3 level cervical plate and screws. I would bill 22855. Then I have Lumbar laminectomy at L4-5 w/diskectomy, foraminotomy, osteophytectomy, and medical facetectomy. I would bill 63047. In a case like this what modifer would I use. I'm thinking 59. </p> http://www.supercoder.com/forum/topic/dorsal-column-stimulator-removal#post-11182 Sun, 05 Feb 2012 03:06:00 +0000 Sanjit Mishra 11182@http://www.supercoder.com/forum/ <p>I think, your question is in the first line, i.e; How to code- removal of Dorsal Column Stimulator and leads on the right side.<br /> Answer: 63661 </p> http://www.supercoder.com/forum/topic/intraoperative-monitoring-1#post-11179 Sat, 04 Feb 2012 19:58:18 +0000 Sanjit Mishra 11179@http://www.supercoder.com/forum/ <p>Report 95920 once per hour even if it is used in conjunction with multiple electrophysiologic studies during a single hour. This procedure should not be reported with nerve conduction studies on the same date of service (95860-95864, 95867-95870). So, we can't bill 95861 here. But, I find no guidelines restricting to bill 95939<br /> with 95920. </p> http://www.supercoder.com/forum/topic/intraoperative-monitoring-1#post-11177 Sat, 04 Feb 2012 04:34:23 +0000 Marina Daviti 11177@http://www.supercoder.com/forum/ <p>Physician performed baseline EMG, SSEP (UPPER AND LOWER EXTREMITIES ),and intraoperative monitoring for 8 hours. Is coding correct or not.<br /> 95861 x 1<br /> 95939 x 1<br /> 95920 X 8 </p> http://www.supercoder.com/forum/topic/dorsal-column-stimulator-removal#post-11173 Sat, 04 Feb 2012 00:14:34 +0000 Ssandra Herron 11173@http://www.supercoder.com/forum/ <p>How to code- removal of Dorsal Column Stimulator and leads on the right side. (Laminectomy not mentioned) Place generator on the left side with new paddle and new electrode leads. I'm thinking 63688 for the removal of implanted spinal neurostimulator pulse generator or receiver and 63661 removal of spinal neurostimulator electrode percutaneous array(s), including fluro, when performed. 63685 insertion or replacement of spinal neurostimulator pluse generator or receiver, direct or inductive coupling. 63650 Percutaneous implantation of neurostimulator electrode array, epidural. Also possibly use one of the following codes for evaluation and programming 95970, 97971, 95972, 95973. Please advise. Thank you </p> http://www.supercoder.com/forum/topic/22848-or-22843#post-11039 Tue, 31 Jan 2012 15:50:03 +0000 James Tritten 11039@http://www.supercoder.com/forum/ <p>Hi Sanjit. What info are you referencing so I can refer back to printed information? Thanks in advance! </p> http://www.supercoder.com/forum/topic/22848-or-22843#post-11024 Mon, 30 Jan 2012 22:40:39 +0000 Sanjit Mishra 11024@http://www.supercoder.com/forum/ <p>Per my info, 22848 is to be used in such case. </p> http://www.supercoder.com/forum/topic/22848-or-22843#post-10997 Mon, 30 Jan 2012 16:48:40 +0000 James Tritten 10997@http://www.supercoder.com/forum/ <p>I have a provider who put iliac bolts bilaterally-here is excerpt from OP Note: (patient has scoliosis)</p> <p>5.5mm cobalt chromic rods were then sized, cut, and bent into lumbar lordosis and thoracic kyphosis. Correction was first carried out across the right side. Some reduction heads and modular regular heads were used for persuasion of the rod. An offset connector was used at the iliac bolt connected to the distal portion of the rod.</p> <p>When the physician puts iliac bolts and connects fixation does this qualify for 22848 or 22843? </p> http://www.supercoder.com/forum/topic/tlif-vs-plif-bundled-with-plf#post-10992 Mon, 30 Jan 2012 00:28:51 +0000 Sanjit Mishra 10992@http://www.supercoder.com/forum/ <p>CPT code 22630 describes both PLIF (posterior) and TLIF (transforaminal) interbody fusion.<br /> Ref:<br /> <a href="http://phx.corporate-ir.net/phoenix.zhtml?c=176872&amp;p=irol-presentations" rel="nofollow">http://phx.corporate-ir.net/phoenix.zhtml?c=176872&amp;p=irol-presentations</a> </p> http://www.supercoder.com/forum/topic/tlif-vs-plif-bundled-with-plf#post-10907 Thu, 26 Jan 2012 22:09:07 +0000 Kim Mchaffie 10907@http://www.supercoder.com/forum/ <p>If a surgeon performs a transforaminal interbody fusion with a posterolateral fusion, at the same level, would this also be a new code '22633'? The TLIF is not mentioned in any of the articles i have read. </p> http://www.supercoder.com/forum/topic/2-differnt-hosptials-in-one-day#post-10825 Wed, 25 Jan 2012 14:40:29 +0000 Sanjit Mishra 10825@http://www.supercoder.com/forum/ <p>I have explained the complexity involved in the E/M part. I think the rest of the care part that you have mentioned may not be the issues causing confusion for you.<br /> Day of Transfer Billing<br /> ========================<br /> A single hospitalist or two hospitalists from the same group might bill both the hospital discharge management code (99238-99239) and an initial hospital care code (99221-99223) when the discharge and admission do not occur on the same day if the transfer is between:</p> <p>•Different hospitals;<br /> •Different facilities under common ownership that do not have merged records;* or<br /> •Between the acute-care hospital and a prospective payment system (PPS)-exempt unit within the same hospital when there are no merged records.<br /> In all other transfer circumstances that do not meet the elements noted above, the physician should bill only the appropriate level of subsequent hospital care (99231-99233) for the date of transfer </p> http://www.supercoder.com/forum/topic/2-differnt-hosptials-in-one-day#post-10807 Tue, 24 Jan 2012 21:09:23 +0000 Kim Frenzel 10807@http://www.supercoder.com/forum/ <p>Patient was operated on at one hospital for acdf and does not have an icu unit. Then complications of a hematoma,so patient was then transferred to another hospital. How do we bill for 2 different hospital stays in one day. </p> http://www.supercoder.com/forum/topic/cpt-code-dural-graft-during-a-craniotomy#post-10689 Thu, 19 Jan 2012 22:42:32 +0000 Try Super 10689@http://www.supercoder.com/forum/ <p>The surgeon was performing a retromastoid craniotomy for decompression of faciacl nerve and it was impossible to close the dura because of the retraction that occurred after it was opened. He sewed a patch and then sealed w/ DuraSeal. Can this be billed separately. None of the codes from 62000-62148 will work. </p> http://www.supercoder.com/forum/topic/suboccipital-craniectomycervical-laminiect-c1-4-intradural-explor-arach-cyst#post-10649 Thu, 19 Jan 2012 15:03:19 +0000 Jasmine Meyeraan 10649@http://www.supercoder.com/forum/ <p>is this how you would code suboccipital craniectomy for decompression fo the foamen magnum with cervical laminectomy 1-4 with decompression of the thecal sac. intraoperative use of microscopy for intradural exploration with decompression of anterior spinal cyst and resection of multiple parachnoid scarring. harvest of pericranial patch graft through same incision dural expansion patch graft both with available pericranium as well as with allograft duramatrix onlay as well as tisseel onlay duraplasty? </p> http://www.supercoder.com/forum/topic/suboccipital-craniectomycervical-laminiect-c1-4-intradural-explor-arach-cyst#post-10648 Thu, 19 Jan 2012 14:59:40 +0000 Jasmine Meyeraan 10648@http://www.supercoder.com/forum/ <p>'61343' '61618' and '20931' </p> http://www.supercoder.com/forum/topic/polar-fusion#post-10608 Wed, 18 Jan 2012 15:01:16 +0000 Sanjit Mishra 10608@http://www.supercoder.com/forum/ <p>CPT 22633 is used for combinedly for both posterior or posterolateral technique and posterior interbody technique. CPT 22612 is only for "posterior or posterolateral technique" and CPT 22630 is only for "posterior interbody technique". But, when both techniques are used combinely, we need to use 22633. So, in 22633, it is stated "Do not report with 22612 or 22630 at the SAME LEVEL".<br /> 22634 each additional interspace and segment (List separately in addition to CPT 22633)<br /> **<br /> How Code combinations are used in some probable scenario:<br /> Use 22614 in conjunction with 22600, 22610, 22612, 22630 or 22633 when performed at a DIFFERENT level.<br /> When performing a posterior or POSTEROLATERAL technique for fusion/arthrodesis at an ADDITIONAL level, use 22614. When performing a posterior INTERBODY fusion arthrodesis at an ADDITIONAL level, use 22632.<br /> When performing a COMBINED posterior or posterolateral technique with posterior interbody arthrodesis at an ADDITIONAL level, use 22634 </p> http://www.supercoder.com/forum/topic/cpt-code-closure-of-the-pseudomeningocele#post-10572 Tue, 17 Jan 2012 17:50:08 +0000 Sanjit Mishra 10572@http://www.supercoder.com/forum/ <p>Sorry! the anatomical section is truly different as you said.<br /> *<br /> Can you please document the detailed Op Report. </p> http://www.supercoder.com/forum/topic/polar-fusion#post-10571 Tue, 17 Jan 2012 17:19:32 +0000 Janet Blankenship 10571@http://www.supercoder.com/forum/ <p>2011 codes for 2 level POLAR (posterior lumbar arthrodesis) with fusion were: 22630, 22632, 22612, 22614, 22842, 22851,&amp; 20931. 2012 CPT states we can no longer use 22612 or 22614 with 22630, to use 22633, but 22633 states not to use with 22630? How should we now code a 2 level POLAR fusion? </p> http://www.supercoder.com/forum/topic/moyamoya#post-10465 Fri, 13 Jan 2012 04:10:11 +0000 Sanjit Mishra 10465@http://www.supercoder.com/forum/ <p>There is no such CPT code for synangiosis to treat moyamoya, so it is safe to code 64999. Details of the procedure may help for a specific CPT. </p> http://www.supercoder.com/forum/topic/moyamoya#post-10442 Thu, 12 Jan 2012 22:27:48 +0000 Loredana Chiriac 10442@http://www.supercoder.com/forum/ <p>What CPT code would be appropriate for frontal craniotomy for synangiosis, dx moyamoya?</p> <p>Thank you. </p> http://www.supercoder.com/forum/topic/trouble-coding-spine-surgery-for-osteomyelitis-destruction-w-kyphosis#post-10424 Thu, 12 Jan 2012 20:07:37 +0000 Mary Hope 10424@http://www.supercoder.com/forum/ <p>a blockquote code em strong ul ol li. </p> http://www.supercoder.com/forum/topic/trouble-coding-spine-surgery-for-osteomyelitis-destruction-w-kyphosis#post-10422 Thu, 12 Jan 2012 20:05:52 +0000 Mary Hope 10422@http://www.supercoder.com/forum/ <p>I do not know what this means; first time user </p> http://www.supercoder.com/forum/topic/trouble-coding-spine-surgery-for-osteomyelitis-destruction-w-kyphosis#post-10421 Thu, 12 Jan 2012 20:04:07 +0000 Mary Hope 10421@http://www.supercoder.com/forum/ <p>Stage I Left thoracoabdominal lateral exposure T11-L3 for T2-L1-L2 corpectomies for decompression of the spinal cord and cauda equina T11-L3 X-mesh expandable cage interbody device with BMP/demineralized bone matric allograft gel:T11-L3 anterior screw/rod interal fixation Stage I</p> <p>Posterior T11-L3 fusion with local bone; T11-L3 Expedium pedicle screw fixation. Stage II </p> http://www.supercoder.com/forum/topic/cpt-code-closure-of-the-pseudomeningocele#post-10351 Wed, 11 Jan 2012 17:46:35 +0000 Try Super 10351@http://www.supercoder.com/forum/ <p>'the approach was not at the base of the cranial, it was frontotemporal. Surgeon removed the bone flap.' </p> http://www.supercoder.com/forum/topic/cpt-code-closure-of-the-pseudomeningocele#post-10330 Wed, 11 Jan 2012 07:53:16 +0000 Sanjit Mishra 10330@http://www.supercoder.com/forum/ <p>I think 61619 is closest, but it also include use of flap for closure. </p> http://www.supercoder.com/forum/topic/transcranial-motor-evoked-potentials-2012-coding#post-10322 Wed, 11 Jan 2012 05:07:42 +0000 Sanjit Mishra 10322@http://www.supercoder.com/forum/ <p>click on "fee schedule" option when the link below opens:<br /> <a href="http://www.supercoder.com/code-lookup/cpt/codes/?code=95939" rel="nofollow">http://www.supercoder.com/code-lookup/cpt/codes/?code=95939</a> </p> http://www.supercoder.com/forum/topic/cpt-code-closure-of-the-pseudomeningocele#post-10306 Tue, 10 Jan 2012 20:42:15 +0000 Try Super 10306@http://www.supercoder.com/forum/ <p>Exploration of left frontotmeporal craniotomy and the closure of the pseudomeningocele CPT code. The patient had previously underwent a resection of a left temporal AVM and has devleoped a psuedomeningocele which didn't improve w/ tapping of the spinal fluid. </p> http://www.supercoder.com/forum/topic/mues-for-op-surgery#post-10298 Tue, 10 Jan 2012 19:32:30 +0000 Sanjit Mishra 10298@http://www.supercoder.com/forum/ <p>The MUE values for CPT code 63661 (removal of spinal neurostimulator electrode percutaneous array(s) . . .) and CPT<br /> code 63662 (removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy . . .) are one (1). Each code descriptor includes the removal of some or all electrode percutaneous arrays and some or all electrode plates/paddles for a neurostimulator pulse generator. If a patient has two separate neurostimulator pulse generators and some or all electrodes are removed for each neurostimulator pulse generator separately, the removal of the percutaneous array(s) or plate(s)/paddle(s) for the second neurostimulator pulse generator<br /> may be reported with modifier 59. </p>