Coding a Decompressive Craniectomy

Question:

In a recent head trauma case, a decompressive craniectomy was performed with a partial temporal lobectomy, due to extensive damage. A hematoma was also evacuated. can we bill for the 61323 decompressive craniectomy code with lobectomy since only a partial lobectomy was done? And what about cooing for the hematoma evacuation?

Answer:

For the procedure described, code 61323, decompressive craniectomy with lobectomy, may be reported, even with a partial lobectomy.  The hematoma evacuation is included in code 61323.

*This response is based on the best information available as of 09/22/22.

Secondary Payor Doesn’t Recognize Consultations

Question:

We have a patient with 2 commercial payers (BCBS and Cigna). A consultation code was submitted to BCBS, and they paid according to our contract. However, Cigna is refusing to process the claim since they no longer pay for consult codes. Am I allowed to change the CPT code and rebill Cigna? Or would I need to change the CPT, refile to the primary as a corrected claim, then send the balance on to Cigna?

Answer:

We suggest calling CIGNA and ask how they want this handled according to their policies. WithMedicareyou have two options: (1) bill the appropriate category and level of service documented (e.g., for outpatient consults [99202-99215] or inpatient consults [99221-99223]) or (2) bill the consultation code, which will result in a denial of payment from Medicare and appeal on paper explaining the situation.

*This response is based on the best information available as of 09/8/22.

Billing for Costotransversectomy

Question:

If the exposure is thoracic, for example in a thoracic corpectomy, and the documentation states a costotransversectomy was performed, can that be billed separately?

Answer:

Costotransversectomy (e.g., 21610) is included in a thoracic corpectomy and not separately billed. Note also that 21610 states “separate procedure” so it is never billed with a more inclusive code.

*This response is based on the best information available as of 08/25/22.

Coding for Spine Procedures that Cross Spinal Junctions

Question:

How do you report a spinal procedure for example, arthrodesis or laminectomies when two spinal are involved. For example., both thoracic and lumbar spine?

Answer:

Report one stand-alone/primary code even when the procedure crosses spine junctional levels. Use the stand-alone code for the spine region where the majority of the procedure/levels is performed.

• Example:T11-S1 posterolateral arthrodesis (T11-T12, T12-L1, L1-L2, L2-L3, L3-L4, L4-L5, L5-S1)
  Use 22612 (the lumbar stand-alone code, since more level were lumbar) and +22614 x 6

*This response is based on the best information available as of 08/11/22.

Removal of Interbody Device

Question:

Can code 20680, removal of implant, be used for removal of a previously placed intervertebral device, such as a PEEK cage?

Answer:

No. There is no code for removal of an intervertebral device – this would be part of an exploration of arthrodesis or new arthrodesis, if performed. Do not use 20680 (removal of implant) for removing spine instrumentation.

*This response is based on the best information available as of 07/28/22.

Coding for Percutaneous Screws and Rod Placement

Question:

I placed posterior percutaneous screws and rods without an arthrodesis. I know I have to use an unlisted code, 22899. How should I price it?

Answer:

Good question. Let’s assume you’re doing +22842 (posterior instrumentation, 3-6 segments) which is an add-on code. Add-on codes are valued for only the intra-operative portion of the service and do not include any value for pre-op (e.g., H&P, discussion with patient), certain intra-operative work (e.g., incision, closure) or post-op work.

Recall that Medicare reduces the payment for secondary stand-alone procedure codes by 50% to account for overlapping pre- and post-op work.

Therefore, we recommend you double your fee for +22842 to achieve your fee for the unlisted code. For example, if your fee for +22842 is $100 then your fee for the unlisted code would be $200.

*This response is based on the best information available as of 07/14/22.