http://www.supercoder.com/forum/ Supercoder - Ask an Expert? Forum: Neurosurgery Coding - Recent Topics en Sun, 12 Feb 2012 12:52:22 +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-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-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/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/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-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-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-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-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/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/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-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/transcranial-motor-evoked-potentials-2012-coding#post-10293 Tue, 10 Jan 2012 19:19:56 +0000 charlotte moore 10293@http://www.supercoder.com/forum/ <p>'95939' is now the code for upper and lower limb TcMEPs....I don't see it on supercoder. how do we know pricing? </p> http://www.supercoder.com/forum/topic/mues-for-op-surgery#post-10262 Mon, 09 Jan 2012 21:24:04 +0000 Pauline Rheaume 10262@http://www.supercoder.com/forum/ <p>I have billed 2 units of 63661 to Medicare for a 10/5/11 dos. One is now denied as too many. I cannot locate the # of MUE's allowed in 2011. Can you please help me. </p> http://www.supercoder.com/forum/topic/cervical-ganglionectomy#post-9481 Mon, 12 Dec 2011 15:58:05 +0000 marianne.schipper 9481@http://www.supercoder.com/forum/ <p>prone position identified C1 arch as well as C2. bovied down C1 and C2 arch to lamina, dissected through venous plexus identifying nerve root placed weck clips over nerve root to clamp, bovied through ganglion using scissors able to cut down and resect the C2 nerve root irrigated and closed. Is this 64744 or some other suggestions please. TIA </p> http://www.supercoder.com/forum/topic/revision-microdiscectomy#post-9404 Thu, 08 Dec 2011 13:35:33 +0000 susan bachmann 9404@http://www.supercoder.com/forum/ <p>if doing a revision microdiscectomy, bilateral L3-4, L4-5, L5-S1 via transforaminal approach would you use 63056? </p> http://www.supercoder.com/forum/topic/lumbar-spondylectomy#post-9410 Thu, 08 Dec 2011 15:33:14 +0000 marianne.schipper 9410@http://www.supercoder.com/forum/ <p>I am looking at possible codes of 63090, or 63307. Has anyone done this enough to lead me in the right direction. L3 corpectomy for complete spondylectomy. Any information on this would be helpful. TIA </p> http://www.supercoder.com/forum/topic/op-report-help#post-7881 Thu, 20 Oct 2011 17:27:44 +0000 Loredana Chiriac 7881@http://www.supercoder.com/forum/ <p>Please help with the next OP report</p> <p>Patients dx are thoracolumbar scoliosis, L1-S1 stenosis, L1-S1 degenerative disk disease</p> <p>L1-Si laminectomies and bilateral facetectomies 63047,63048x4<br /> L2-L5 posterior diskectomies<br /> L2-L5 posterior interbody arthrodesis 22630,22632x2<br /> Intervertebral device at L2-L3,L3-L4,L4-L5 22851x3<br /> T10-S1 posterior segmental instrumentation 22843<br /> T10-S1 posterior and posterolateral arthrodesis 22612,22614x7</p> <p>Are this codes correct or should I use 22802 for arthrodesis? Does 22802 includes posterior and interbody arthrodesis?</p> <p>Thank you so much. </p> http://www.supercoder.com/forum/topic/transnasal-approach#post-8965 Mon, 21 Nov 2011 19:07:18 +0000 Loredana Chiriac 8965@http://www.supercoder.com/forum/ <p>Hello everyone,</p> <p>I know I posted this question before, but I am looking to see if anyone has something new regarding this approach….dr does 61608 but the approach is not open, is transnasal…I am using 31288-50 as of now, but RVU’s-8 are considerably less than an open approach which runs around 91 RVU’s… my doctor is saying is actually more work to do endoscopic approach, but less invasive and also he doesn’t want to use unlisted code..</p> <p>Any thoughts? </p> http://www.supercoder.com/forum/topic/cpt-code-for-thoracic-corpectomy-contralaterally#post-8623 Fri, 11 Nov 2011 20:47:51 +0000 Supercoder Supercoder 8623@http://www.supercoder.com/forum/ <p>They went carefully contralaterally removing the right side of the vertebral body of T9 nd T10. After that they went more medial in order to expose the dura at T8-T9 and T10 levels </p> http://www.supercoder.com/forum/topic/minimally-invasisve-percutaneous-fusion-cpt-code-please#post-8182 Fri, 28 Oct 2011 16:05:38 +0000 anh tran 8182@http://www.supercoder.com/forum/ <p>PROCEDURE PERFORMED<br /> Minimally invasive percutaneous fusion, L4-5, L3-4, performed with NuFix dowels and Trinity bone product in the facet joint. Surgery performed under fluoroscopy.</p> <p>PROCEDURE<br /> The patient was brought to the operating room, and after satisfactory sedation had been obtained, the patient was placed prone on the Relton-Hall frame on the radio penetrable extension of the operating<br /> table. The back was then prepped with ChloraPrep twice. Then the back was draped. Under fluoroscopic control, we inserted a 5/16 K-wire into the facet joint at L4-5 and later L3-4 on the left, then we slid<br /> the guide over the K-wire, and then the working portal was slid down over the guide. The K-wire and guide were then removed, and using a 5.0 mm drill, we drilled holes into the facet joint at L4-5 and<br /> then L3-4 and inserted a 5.5 mm machined dowel plug into the facet joint with approximately 1.25 mL of Trinity bone product. This was all impacted into the facet joint. Then the working portal was removed<br /> and transferred to the second location at the L3-4 level. We then closed the subcutaneous tissue with 3-0 Vicryl. The skin was closed with interrupted subcuticular sutures of 4-0 Monocryl and Dermabond. The operating surgeon then moved to the opposite side of the table so we could do the same procedure on the right side at L4-5 and L3-4. At the conclusion of the procedure, Steri-Strips were applied to the<br /> incisions, and the patient had sterile dressing applied to her back. She was carefully log-rolled onto the bed and taken to recovery in good condition. Estimated blood loss less than 5 mL. The patient reacted satisfactorily from the anesthetic and moved both lower extremities without limitation or difficulty. </p> http://www.supercoder.com/forum/topic/spinal-robot#post-8149 Thu, 27 Oct 2011 22:44:42 +0000 Loredana Chiriac 8149@http://www.supercoder.com/forum/ <p>Can anyone help with a CPT code foe spinalrobot and CT protocol for the robot? Is done to correct T10-S1 scoliosis.</p> <p>Thank you </p> http://www.supercoder.com/forum/topic/axillary-stab-wound#post-7849 Wed, 19 Oct 2011 21:05:13 +0000 Loredana Chiriac 7849@http://www.supercoder.com/forum/ <p>repair of right ulnar, median, radial nerves as well as large cutaneus peripheral nerve branch.</p> <p>Am I really off with 64835-dx 955.7;<br /> 64836-51-dx. 955.2<br /> 64835-51-dx. 955.1<br /> 64837 dx. 955.3</p> <p>Thank you </p> http://www.supercoder.com/forum/topic/arthroplasty#post-7583 Tue, 11 Oct 2011 21:53:14 +0000 Loredana Chiriac 7583@http://www.supercoder.com/forum/ <p>for a total disk arthoplasty only 22856 is to be billed or it is a cpt code for the artificial device which can be billed?</p> <p>thank you </p> http://www.supercoder.com/forum/topic/failure-arthroplasty#post-7615 Wed, 12 Oct 2011 16:57:02 +0000 Loredana Chiriac 7615@http://www.supercoder.com/forum/ <p>Hello everyone,</p> <p>If physician does removal of total disk arthoplasty, C5-C6 anterior arthrodesis with placement of prosthetic intervertebral device with PEEK cage and instrumentation, should I just bill 22864 for the removal of the arthoplasty, or 22551;22851;22845;20931 for the fusion? Per CCI 22864 cannot be billed with 22551,22851,22845,20931<br /> Whisch codes should be billed? </p> http://www.supercoder.com/forum/topic/thank-you#post-7579 Tue, 11 Oct 2011 20:24:51 +0000 Loredana Chiriac 7579@http://www.supercoder.com/forum/ <p>Can anyone help with "exploration and decompression of rt brachial plexus, resection of the right cervical rib and intraoperative stimulation of the brachial plexus".</p> <p>Thank you. </p> http://www.supercoder.com/forum/topic/cervical-traction#post-7398 Mon, 03 Oct 2011 23:01:33 +0000 Loredana Chiriac 7398@http://www.supercoder.com/forum/ <p>Can anyone help with a CPT code for placement of occipital cervical traction?</p> <p>Thank you. </p> http://www.supercoder.com/forum/topic/i-fuse-system#post-6030 Mon, 08 Aug 2011 22:41:35 +0000 Loredana Chiriac 6030@http://www.supercoder.com/forum/ <p>Anyone can help with a cpt code for "sacroiliac fixation using I fuse sysytem"?</p> <p>thank you </p> http://www.supercoder.com/forum/topic/arthrodesis#post-7347 Fri, 30 Sep 2011 16:17:23 +0000 Loredana Chiriac 7347@http://www.supercoder.com/forum/ <p>posterior or posterolateral arthrodesis should be billed by vertebra or interspace 22600-22614?</p> <p>thank you </p>