http://www.supercoder.com/forum/ Supercoder Forum Forum: Neurosurgery Coding - Recent Posts en Tue, 07 Sep 2010 06:20:40 +0000 http://www.supercoder.com/forum/topic/i-need-help-coding-this-surgery-op-note-i-coded-31085#post-1231 Fri, 16 Jul 2010 19:00:38 +0000 Theresa Grimaldo 1231@http://www.supercoder.com/forum/ <p>I cannot find where both are bundling to bill out together. What about the pericranial graft? </p> http://www.supercoder.com/forum/topic/i-need-help-coding-this-surgery-op-note-i-coded-31085#post-1209 Tue, 13 Jul 2010 20:37:05 +0000 Theresa Grimaldo 1209@http://www.supercoder.com/forum/ <p>thank you. </p> http://www.supercoder.com/forum/topic/i-need-help-coding-this-surgery-op-note-i-coded-31085#post-1197 Tue, 13 Jul 2010 06:25:13 +0000 alex wills 1197@http://www.supercoder.com/forum/ <p>This procedure is more extensive so the code 31085 does not seems to fully cover. I could rather come across with 61582 (Craniofacial approach to anterior cranial fossa; extradural, including unilateral or bifrontal craniotomy, elevation of frontal lobe(s), osteotomy of base of anterior cranial fossa) which I think is much closer to the procedure. </p> http://www.supercoder.com/forum/topic/i-need-help-coding-this-surgery-op-note-i-coded-31085#post-1183 Fri, 09 Jul 2010 15:03:33 +0000 Theresa Grimaldo 1183@http://www.supercoder.com/forum/ <p>POSTOPERATIVE DIAGNOSIS(ES):<br /> Ruptured posterior wall of the frontal sinus.</p> <p>OPERATIONS PERFORMED:<br /> Craniotomy for exenteration of a frontal sinus along with harvesting and<br /> use of a vascularized pericranial graft.</p> <p>COMPLICATIONS:<br /> None.</p> <p>DISPOSITION:<br /> The patient was transferred in stable condition to the ICU.</p> <p>SUMMARY:<br /> The patient was brought to the operating room and underwent uneventful<br /> intubation. Preoperative dose of mannitol, steroids, and antibiotics was<br /> given. The patient time-out was performed. The patient was placed with<br /> the Mayfield pins up. A curvilinear ??&lt;__________&gt; superior incision was<br /> planned based on the patient's preoperative wishes which he did not wish<br /> for a Z incision. The patient was then prepped in the usual fashion<br /> including alcohol, followed by chlorhexidine, followed by DuraPrep, all of<br /> them x2. The patient was draped in the usual sterile fashion. Local<br /> anesthetic was used to anesthetize the skin. A 15-blade was used to score<br /> the epidermis. I then used snaps to be able to split the skin and galea<br /> from the pericranium. Using that technique, I was able to open the<br /> incision without injuring the pericranium. A pericranial ??&lt;__________&gt;<br /> graft was elevated, first using the monopolar to Bovie the periphery and<br /> then elevating with a periosteal elevator. A pericranial flap had been<br /> injured in the area of his previous injury and was repaired using 3-0<br /> Vicryl. Of note is that subperiosteal dissection was then carried down all<br /> the way to the orbital rims. The skin was then flapped down and held in<br /> place with hooks and of note is that underneath the skin I had placed<br /> Kerlixes that were bunched up into cigars in order to avoid any acute<br /> angles at the skin of the forehead and avoid any closure of that skin. The<br /> periphery was then covered with Ray-Tecs which were kept moist during the<br /> entire case. Following that, 2 bur holes were created on the right and on<br /> the left and the AM-8 was used to drill a burr off the central part of the<br /> calvaria to avoid any injury to the sinus. A periosteal elevator was used<br /> to elevate the dura. A router was then used to go ahead and elevate the<br /> bone flap. This did come across the sinus anterior and posterior wall as<br /> expected. Following that, the bone flap, I went ahead and removed the<br /> posterior wall of the sinus from the bone flap and went ahead and used the<br /> high-speed drill to drill away the entire surface of the remaining anterior<br /> surface of the frontal sinus that was on the bone flap in order to remove<br /> all mucus-producing cells. This was done with a high-speed drill. Of note<br /> is that the correction of the anterior deficit was performed by Plastic<br /> Surgery. Following that, I went ahead and placed tack-up sutures around<br /> the periphery of the craniotomy, waxed the bony bleeding and went ahead and<br /> placed both FloSeal and Surgicel around the gutters and tacked it up with<br /> tack-up sutures. Following that, I went ahead and exenterated the sinus by<br /> removing the posterior wall of the sinus using the Leksell and the<br /> high-speed drill. This actually had surprisingly large nasal frontal ducts<br /> and as seen by the preoperative CAT scan had pneumatized orbital rims for<br /> walls. For that reason, extensive removal of the posterior wall was<br /> performed, leaving a very small ledge all the way in the back in order to<br /> be able to anchor the material with which I would pack the nasal frontal<br /> sinus. After I was satisfied with the resection of the posterior wall, I<br /> went ahead and then used the diamond drill to again drill off all cells<br /> producing any mucus in order to avoid a mucocele formation in the future.<br /> This was done using a high-speed drill and no irrigation so that I could<br /> constantly see where I had previously drilled. Very careful attention was<br /> made to not skip or miss any point with the drilling with the high-speed<br /> diamond drill. I was very satisfied with the cleaning of the sinus.</p> <p>Of note is that prior to that, I had stripped any of the obvious sinus<br /> mucosa using a periosteal freer and had packed it down marsupializing it<br /> into the nasal frontal duct. Of note is that there was no evidence of any<br /> leakage of CSF from any areas of the dura. Following that, I went ahead<br /> and packed the nasal frontal duct with Gelfoam that had been soaked in<br /> antibiotic bacitracin ointment. I went ahead and then imbricated the<br /> pericranial graft inwards, packing it down into the nasal frontal duct. I<br /> used a parachute technique in order to secure it down deep into the dura.<br /> 4-0 Nurolon was used for that reason. This was done in order to imbricate<br /> the pericranial graft down into the nasal frontal duct and to the area<br /> where the previous sinus existed. This was done again using a parachute<br /> technique. At that point, I inspected for any bleeding, and any bleeding<br /> was controlled using bipolar cautery. The remainder of the operation,<br /> including the replacement of the craniotomy and the closure, was performed<br /> by Plastic Surgery. Of note is that I did place 2 tack-up stitches on the<br /> dura centrally which Plastic Surgery would tent up through the craniotomy<br /> once they replaced it. The patient tolerated my part of the procedure with<br /> no complications. </p> http://www.supercoder.com/forum/topic/expanding-hematoma#post-689 Thu, 15 Apr 2010 17:54:16 +0000 Betsy Rivera 689@http://www.supercoder.com/forum/ <p>thank you so much for your help </p> http://www.supercoder.com/forum/topic/expanding-hematoma#post-687 Thu, 15 Apr 2010 16:39:15 +0000 apoorba ganguly 687@http://www.supercoder.com/forum/ <p>In this case, as I said earlier, primary Dx will be 998.12, and secondary Dx will be V45.4. </p> http://www.supercoder.com/forum/topic/expanding-hematoma#post-685 Thu, 15 Apr 2010 14:32:37 +0000 Betsy Rivera 685@http://www.supercoder.com/forum/ <p>Well the fusion was on 1/26/10 &amp; the evacuation for the hematoma was on 1/27/10</p> <p>brief history states:<br /> Patient admitted status post anterior cervical discectomy fusion on 1/26 with expanding neck.. I explained to the patient that he likely has bleeding and we should return to the operating room for decompression and for hemostasis in order to avoid respiratory complications. </p> http://www.supercoder.com/forum/topic/expanding-hematoma#post-679 Thu, 15 Apr 2010 09:11:40 +0000 apoorba ganguly 679@http://www.supercoder.com/forum/ <p>If the current hematoma is not linked with the previously done ACDF surgery, then code as this -- code 920 as the primary Dx, and you can also code V45.4 as secondary Dx, to indicate the "status ACDF" condition. </p> <p>If the current "expanding hematoma of neck" is documented as a complication developed after the ACDF surgery and linked to the ACDF, then code 998.12 as the primary code and V45.4 as the secondary dx. </p> http://www.supercoder.com/forum/topic/expanding-hematoma#post-678 Thu, 15 Apr 2010 08:34:42 +0000 alex wills 678@http://www.supercoder.com/forum/ <p>There is no specific code for expanding hematoma so you need to code 920 only. </p> http://www.supercoder.com/forum/topic/expanding-hematoma#post-675 Thu, 15 Apr 2010 01:17:38 +0000 Betsy Rivera 675@http://www.supercoder.com/forum/ <p>what diagnosis can I use for</p> <p>"status post anterior cervical discectomy fusion with expanding hematoma of neck"?</p> <p>thank you </p> http://www.supercoder.com/forum/topic/ilif#post-337 Wed, 10 Feb 2010 20:18:32 +0000 Toni Baker 337@http://www.supercoder.com/forum/ <p>Thank you Apoorba. We have not done one yet but my docs are looking at training for it and wanted me to research it from a coding and payment point of view. They are looking at doing one level lumbar. Nothing I've seen would indicate it would or could be interbody. Sometimes it's just good to have someone else take a look and maybe see something differently. I appreciate the second set of eyes. Toni </p> http://www.supercoder.com/forum/topic/ilif#post-328 Wed, 10 Feb 2010 11:46:48 +0000 apoorba ganguly 328@http://www.supercoder.com/forum/ <p>Initially I was a bit hesitant to choose between 22612 and 22630 (for spinal fusion). But as you have mentioned about "minimal incisions and minimal lamina removal", the probable posterior fusion code should be - 22612 (22630 removes out more of lamina / disc). As for "spinous process plate", +22841 would be fine if the Sx is performed on 1-2 lumbar intervertebral discs. If the no. of lumbar segments operated are more like 5-6 or more and if rods-hooks are utilized then the code would become +22842. exact choice of code will depend upon the detailed OP notes. But from the limited info that I can see in the query, I would go with the codes you have chosen, Toni :) i.e. 22612, +22841, +20931. No modifier is required. </p> http://www.supercoder.com/forum/topic/ilif#post-317 Tue, 09 Feb 2010 13:43:07 +0000 Toni Baker 317@http://www.supercoder.com/forum/ <p>Has anyone seen or performed this Interlaminar Lumbar Instrumented Fusion, using ExtenSure allograft, and Affix spinous process plate? It looks like a posterior fusion, with minimal incisions and minimal lamina removal, that uses the allograft spacer and plate. I have some literature saying the spinous process plate would be 22841. (22612, 22841, 20931???) Any feedback for this coding would be appreciated. </p> http://www.supercoder.com/forum/topic/neurointerventional-coding#post-198 Sat, 09 Jan 2010 15:52:48 +0000 Pamela Franklin 198@http://www.supercoder.com/forum/ <p>Anna,</p> <p>Dr Z's Interventional Radiology Coding Reference is an excellent resource for all procedures within this field. HCPRO also offers a wonderful resource with a book titled Interventional Coding that you should find beneficial. Lastly, Coding Strategies, Inc offers an incredibly informative seminar several times per year that I have found extremely beneficial from a coding/billing perspective for interventional coding.</p> <p>Hope these suggestions help, best of luck to you!</p> <p>Anita L Rickman, CCS<br /> Coding Coordinator, JHSMH </p> http://www.supercoder.com/forum/topic/neurointerventional-coding#post-194 Fri, 08 Jan 2010 03:03:14 +0000 Anna Martinez 194@http://www.supercoder.com/forum/ <p>Is any one else doing angiography/stenting procedures. I am really confused on the selective catheter placement descriptions ie 1st,2nd 3rd etc. I have tried to research and am still at a loss. Any coding neurointerventional resources available????</p> <p>Thank you,<br /> Anna </p> http://www.supercoder.com/forum/topic/thoracic-interbody-fusion-cage#post-184 Mon, 04 Jan 2010 23:12:14 +0000 Anna Martinez 184@http://www.supercoder.com/forum/ <p>I forgot to metion it's posterior. It's like a PLIF for thoracic. ?? </p> http://www.supercoder.com/forum/topic/emg-billing#post-181 Thu, 31 Dec 2009 07:38:53 +0000 alex wills 181@http://www.supercoder.com/forum/ <p>Just see the fee schedule at Supercoder.com where it has the option to check if a Tc or 26 modifier is allowed for a CPT or HCPCS codes. Once you are there scroll down for this info, which you can find under the Global &amp; Other Info option.</p> <p><a href="http://www.supercoder.com/coders-toolkit/fee-schedule/" rel="nofollow">http://www.supercoder.com/coders-toolkit/fee-schedule/</a> </p> http://www.supercoder.com/forum/topic/emg-billing#post-179 Tue, 29 Dec 2009 21:32:24 +0000 Tara Johnson 179@http://www.supercoder.com/forum/ <p>Thanks for your response. I guess I am a little foggy on technical components. I am used to surgery billing and we do not have to attach any modifiers when we do anything laparoscopic and use the hospitals scope. Thanks for your input. Do you know of any resources giving specific information on procedures that apply to technical components? </p> http://www.supercoder.com/forum/topic/emg-billing#post-177 Tue, 29 Dec 2009 10:41:15 +0000 Ash 177@http://www.supercoder.com/forum/ <p>Hi Tara,</p> <p>When the hospital is billing for the EMG, is it not a fraud to bill for the technical compoent again? The equipments belong to the hospital which is billing for the technical component. Even if the doctor is performing, reading and interpreting, his services are limited to the professional component only, i.e. with a modifier 26. </p> http://www.supercoder.com/forum/topic/emg-billing#post-176 Mon, 28 Dec 2009 20:37:00 +0000 Tara Johnson 176@http://www.supercoder.com/forum/ <p>If a Dr uses a hospital to perform EMG's, but otherwise does everything for procedure (performing, reading and interpretation), can we bill without modifier-26 if the hospital is also billing for the EMG? </p> http://www.supercoder.com/forum/topic/thoracic-interbody-fusion-cage#post-169 Wed, 23 Dec 2009 08:06:01 +0000 Ash 169@http://www.supercoder.com/forum/ <p>Are you not looking for 22556? </p> http://www.supercoder.com/forum/topic/thoracic-interbody-fusion-cage#post-168 Tue, 22 Dec 2009 19:24:30 +0000 Anna Martinez 168@http://www.supercoder.com/forum/ <p>I think I'm wasting my time looking for thoracic interbody fusion/cage. What is everyone else doing? unlisted? </p> http://www.supercoder.com/forum/topic/cpt-code-22851-x-3-does-not-apply-as-the-arthrodesis-includes-this-as-an-element#post-159 Wed, 16 Dec 2009 04:15:29 +0000 Anna Martinez 159@http://www.supercoder.com/forum/ <p>Actually, BMP is coded as 20930 and if your using 22851 as a implant device such as a cage or PEEK spacer, then our using 22851 correctly. </p> http://www.supercoder.com/forum/topic/cpt-code-22851-x-3-does-not-apply-as-the-arthrodesis-includes-this-as-an-element#post-143 Tue, 08 Dec 2009 07:39:38 +0000 boby brown 143@http://www.supercoder.com/forum/ <p>In this scenario do you mean to say that for Bone Morphogenetic Protein (BMP)the insurance is denying CPT code 22851. As for BMP (bone morphogenetic proteins), you should not report 22851 for this service. BMP is a special growth factor for the induction of new bone formation. Surgeons mix this product with allograft or autograft bone used during fusion, for instance.<br /> I would suggest CPT code 20931 for BMP. If not then do let me know. Good luck!! </p> http://www.supercoder.com/forum/topic/cpt-code-22851-x-3-does-not-apply-as-the-arthrodesis-includes-this-as-an-element#post-140 Tue, 08 Dec 2009 00:10:13 +0000 Shawn Srishan 140@http://www.supercoder.com/forum/ <p>Insurance Company claims that Afthrodesis includes '22851' as an element, and since cannot be billed seperately in the following procedures described in the operatingreport: Posterior segmental spinal instrumentation T10 – S1; bilateral pelvic instrumentation, transforaminal lumbar interbody fusion L3-L4, L4-L5, and L5-S1 with intervertebral devises x3; Posterior posterolateral arthrodesis T10-T11, T11-T12, T12-L1, L1-L2 through L2-L3, L3-L-4, L4-L5, L5-S1 with local autograft and morselized allograft, three large BMP kits.</p> <p>Is the Insurance company correct? </p> http://www.supercoder.com/forum/topic/neurostimulator-implantinsertion#post-45 Thu, 01 Oct 2009 16:31:38 +0000 boby brown 45@http://www.supercoder.com/forum/ <p>I do agree with you Betsy, but also please be sure that rather than an epidural electrode array, the neurosurgeon may instead insert a plate or paddle electrode, via laminectomy, to provide stimulation.</p> <p>To describe such placement of a plate or paddle electrode, you would report 63655 (Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural).</p> <p>Before you file, check with your payer or Medicare carrier for a complete list of preconditions and allowable diagnoses for spinal cord stimulation coverage. </p> http://www.supercoder.com/forum/topic/neurostimulator-implantinsertion#post-42 Tue, 29 Sep 2009 02:03:59 +0000 Betsy Rivera 42@http://www.supercoder.com/forum/ <p>you should report 63650, 63650-51 if two arrays were inserted and if generator was inserted you should use 63685 for the creation of the pocket for the IPG. If your doctor purchased the electrodes, you should also bill L8680x16, usually each array comes with 8 electrodes on it. </p> http://www.supercoder.com/forum/topic/neurostimulator-implantinsertion#post-24 Tue, 22 Sep 2009 09:10:01 +0000 supercoder.newbee 24@http://www.supercoder.com/forum/ <p>Our neurosurgeon implants a spinal neurostimulator. The neurosurgeon positions two electrode arrays in the epidural space for treatment of bilateral leg pain. How should I report this? </p>