Microscope with 63030 Issues

Question:

Why do some insurance companies pay for the microscope (+69990) when we bill it for a lumbar discectomy (63030) and some don’t? I don’t get it. What recourse do we have if it isn’t paid?

Answer:

First, CPT guidelines do not list 63030 as inclusive of the microscope so reporting 63030 and +69990 together is accurate per the AMA’s CPTcodingrules.  That said, Medicare has a National Correct Coding Initiative (NCCI) edit preventing payment for +69990 when billed with 63030 (and many other laminectomy codes).  This is Medicare’spaymentrule. Some non-Medicare payors follow this NCCI bundling edit and also will not pay.  On the other hand, some non-Medicare payors don’t follow this edit and do reimburse +69990 when reported with 63030.  If you are contracted with the payor who does not reimburse +69990, with 63030, then you likely don’t have much recourse because you are contractually obligated to follow their payment rules.

*This response is based on the best information available as of 06/28/18.

ICD-10-CM Code for DBS Battery/Generator Replacement

Question:

We are using the diagnosis code of T85.190 (Other mechanical complication of implanted electronic neurostimulator of brain electrode (lead), initial encounter) for the replacement of a deep brain stimulator generator (2 leads, 61886) because the battery died. This code requires a 7th digit and we are struggling with the difference between initial encounter (A) and subsequent encounter (D) for this case. It’s not an injury or fracture which makes it more difficult to decide. Can I get your expertise?

Answer:

A couple of Question:s/ comments about this:

1. Why are the leads being replaced? Are they dislodged or out of place? If so, then a T code is appropriate.
2. For routine battery replacements because the battery has reach its end of life (a normal occurrence – not a complication), we’d use the condition code such as Parkinson’s disease (G20) and not a T code.

If you’re using a T code then you have 3 choices for the 7th character: A for initial encounter, D for subsequent encounter, and S for sequela.  The service is not being performed for a sequela so you can eliminate the 7th character of S.  So now you’re between A and D.  Since the patient is receiving active treatment for the “other mechanical complication”, you’ll use the 7th character of A (T85.190A).

*This response is based on the best information available as of 05/31/18.

ICD-10-CM Code for Spinal Stenosis

Question:

Should the code set M48.0- be used for both central canal stenosis and foraminal stenosis?

Answer:

There is no distinction made in ICD-10-CM for central canal stenosis vs foraminal stenosis. Therefore, the M48.0- code covers both/all types of spinal stenosis.

*This response is based on the best information available as of 05/03/18.

Evacuation of Cervical Epidural Hematoma

Question:

How do I code a cervical laminectomy with extradural epidural hematoma evacuation?  I was thinking about using 63265 but my co-worker said this code is for a tumor removal and not for a hematoma.

Answer:

Sorry, but your co-worker is incorrect.  The code series, 63265-63268, is for laminectomy procedures to remove intraspinal lesions “other than neoplasm” so these codes would never be used for tumor removal.

Examples of extradural non-neoplasm lesions where 63265-63268 are used include a hematoma or abscess.

*This response is based on the best information available as of 04/19/18.

Placement of Lumbar Subarachnoid Drain

Question:

My neurosurgeon states he placed a subarachnoid drain in the lumbar spine after a craniotomy for CSF leak repair procedure. He thinks the correct code is 62350.  Is this accurate?

Answer:

No.  You’ll use 62272 (Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter) instead.  CPT 62350 is for placement of a catheter for long-term medical administration such as that necessary for a spinal pump; it is not the correct code for a lumbar drain.

*This response is based on the best information available as of 03/15/18.

Reinsertion (22849) vs. Segmental (22842) Instrumentation

Question:

I have a question about reinsertion of spinal instrumentation vs posterior segmental instrumentation. We have a patient who our neurosurgeon performed an exploration previous L4-S1 fusion with removal of rods bilaterally, L3-L4 laminectomy with PLIF and posterolateral fusion with placement of pedicle screws at L3 and new rods from L3-S1.

I have researched and would like to verify if we could bill the CPT 22849 for replacement of the instrumentation from L4-S1 plus CPT 22842 for the new pedicle screws and rods. I spoke to a coding hotline who said 22849 and 22842 were accurate but I thought I better check with an expert – you!

Answer:

I’m so glad you asked because you’ve been give inaccurate advice. CPT 22849 is reported when you remove and replace instrumentation at the exact same level(s); in this case you extended the instrumentation so 22849 does not apply. When you extend the instrumentation meaning adding it to an adjacent level, you report only the “new code” such as 22842.

*This response is based on the best information available as of 06/08/17.