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Suboccipital craniotomy to remove posterior fossa tumor, left EVD, C1 Laminecto

Deborah h Posted Tue 21st of July, 2015 12:57:11 PM

When coding a suboccipital craniotomy for removal of a posterior fossa midline tumor (61521)?; EVD inserted at a different stab wound (61210)?; what would you code the C1 laminectomy with neurophysicological monitoring? Please give all code(s) for this case; 1. subocciptial craniotomy for removal of posterior fossa midline tumor? 2. EVD ? 3. C1 laminectomy with neurophysicological monitoring? Would the physician bill for the neurophysicological monitoring?If so, what code? Please include references.

SuperCoder Answered Wed 22nd of July, 2015 03:12:13 AM

Well, for CPT 61521 and CPT 61210 seems appropriate for tumor removal and EVD. For C1 laminectomy CPT 63045 can be used if it is done for decompression and neurophysiological monitoring can be codes with CPT 95940/95941 when it performed intraoperatively. Hope it helps!

Deborah h Posted Wed 22nd of July, 2015 09:01:11 AM

I thought the surgeon wasn't able to bill for the cpt code(s) 95940/95941; it has to be a provider other than the surgeon or anesthesia staff conducting the neurophysiology, test; please confirm.

SuperCoder Answered Thu 23rd of July, 2015 05:09:16 AM

Well, you are absolutely right, it has to be a provider other than the surgeon or anesthesiologist conducting the neurophysiology. If it is done by the same surgeon then it cannot be billed reason being CPT code 95940 is a column 2 code for 61521, These codes cannot be billed together in any circumstances. Hope it helps!

Deborah h Posted Mon 27th of July, 2015 18:22:53 PM

Please refer to my original question on this thread; you told me to charge 63045 for the laminectomy; however, if the laminectomy was done for exposure to remove the tumor; are you still able to charge for the laminectomy; please give references to support your answer.

SuperCoder Answered Tue 28th of July, 2015 02:44:11 AM

Well, as I mentioned earlier, for C1 laminectomy CPT 63045 can be used if it is done for decompression. But when you are performing a procedure to removal of tumor through craniotomy, then purpose of the laminectomy need to be check. So, as per your documentation laminectomy was performed for exposure to the tumor, it is suggested to append modifier 22 with the procedure code 61521. In order to append modifier 22 to a surgical procedure, check that the physician documented the reason(s) why the work he performed was more than he typically performs, and the documentation should include any or all of the following:
–Increased intensity
–Additional time
–Technical difficulty
–Severe patient condition, which causes the surgery to be difficult, dangerous to the patient, and requires additional physical and mental effort from the physician.
Hope it helps!

Deborah h Posted Tue 28th of July, 2015 08:40:56 AM

So you are saying not to charge 63045(exposure), but add a 22 modifier to 61521,if the surgery was more difficult;correct?

SuperCoder Answered Wed 29th of July, 2015 04:58:12 AM

Yes, that’s exactly what I mean, add 22 modifier to 61521 as the procedure was difficult than it usually is. Thanks for explaining the details and keeping patience.

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