Surgery Coding: Never Miss These 5 Add-On Codes in Cranial Procedures
Avoid Using Modifier 51 with Add On Codes +69990 or +61781
Billing for cranial surgery has always been considerably tricky. Typically, CPT® code for craniotomy (61320-61571) is the principal component in most cranial surgery procedures. However, surgeons also perform few other procedures along with craniotomy. Because of the complex nature of most cranial procedures, the use of modifier 51 and 59 becomes complicated. If the neurosurgery CPT® codes for additional procedures and techniques are not billed correctly, one may miss-out on billing. It is imperative to be cautious in order to keep your practice profitable. Needless use of modifier may land you on unnecessary payer audits.
Microdissection Should Be Billed Only Oince Per Session
When an operating microscope is used for the purpose of microdissection surgery, CPT® code for microdissection +69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) must be reported along with the CPT® code of the primary craniotomy procedure. Only one unit of CPT® code +69990 can be billed per operative session. It does not matter of how many times the surgeon has used the operating microscope for microdissection during a single session in the operative room. Gregory Przybylski, MD, director of department of neurosurgery, at New Jersey Neuroscience Institute, JFK Medical Center says that the add-on code +69990 for microdissection must be billed right after the craniotomy code. This will improve the probability of proper payment for the add-on code. This is because there are many neurosurgery codes to which microdissection is not applicable, he adds. Also, it is important to remember that this code can be billed only once per operative session and not per procedure code. For example, as per CCI edit effective from January 1, 2014, CPT® code +69990 is bundled into CPT® code 66183 (insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach)*. Przybylski has also shared some tips on how to really confirm the use of operative microscope for microdissection during cranial surgery. Przybylski also talks about how surgeons should document what anatomic structures they have dissected with microdissection technique. One should not report the use of surgical loupes with CPT® code +69990. Though surgical loupes are utilized to magnify the surgical field, code +69990 is reported for the surgical work of microdissection that is performed using only the operating microscope, Przybylski says. This is how surgical dissection applicable to every operation is distinguished from actual microdissection procedure. Some payers have very restricted set of procedures with which they usually permit the use of add on code +69990. It is a good idea to check with the payer whether, the use of operating microscope can be reported.