2009
Coding Companion for
Neurosurgery/Neurology
A comprehensive illustrated guide to coding and reimbursement
00 ATNN Pre...
© 2008 Ingenix
Coding Companion for Neurosurgery/Neurology Contents
Contents
Getting Started with Coding Companion ..........
61345
Other cranial decompression, posterior
fossa
61345
Explanation
The physician lowers pressure in the brain
caused by ...
64752-64760
Transection or avulsion of; vagus nerve
(vagotomy), transthoracic
64752
vagus nerves limited to proximal
stoma...
CPT only © 2008 American Medical Association. All Rights Reserved. © 2008 Ingenix
Coding Companion for Neurosurgery/Neurol...
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Coding Companion for Neurosurgery/Neurology

  1. 1. 2009 Coding Companion for Neurosurgery/Neurology A comprehensive illustrated guide to coding and reimbursement 00 ATNN Prelim .fm Page1 Friday,Novem ber21,2008 5:08PM
  2. 2. © 2008 Ingenix Coding Companion for Neurosurgery/Neurology Contents Contents Getting Started with Coding Companion .............................i Skin .....................................................................................1 Repair..................................................................................3 General Musculoskeletal ....................................................25 Head..................................................................................43 Neck/Thorax......................................................................47 Back...................................................................................51 Spine.................................................................................54 Pelvis/Hip...........................................................................90 Femur/Knee.....................................................................100 Foot/Toes.........................................................................102 Endoscopy.......................................................................104 Respiratory ......................................................................105 Arteries/or Veins ..............................................................108 Stomach..........................................................................111 Skull/Brain .......................................................................117 Spinal Nerves ..................................................................252 Extracranial Nerves ..........................................................327 Ocular Adnexa.................................................................437 Auditory ..........................................................................438 Medicine Services............................................................445 Appendix.........................................................................492 CCI Edits..........................................................................517 Evaluation and Management ..........................................519 Index...............................................................................541 00 ATNN TOC.fm Pagei Friday,Novem ber21,2008 5:27PM
  3. 3. 61345 Other cranial decompression, posterior fossa 61345 Explanation The physician lowers pressure in the brain caused by excess fluid. The patient is placed in a seated position or prone. The physician makes an incision in the midline extending from the posterior mid-scalp to the midcervical region. Dissection is continued to the skull. Drills and saws are used to open the occipital bone to enter the posterior fossa of the skull. The brain is decompressed by removal of blood and pathological tissue. The occipital bone is secured with sutures, wires, or plates and screws. The scalp and neck are sutured closed in layers. Coding Tips For orbital decompression by lateral wall approach, Kroenlin type, see 67445. ICD-9-CM Procedural Other craniotomy01.24 Anesthesia 0021861345 ICD-9-CM Diagnostic Malignant neoplasm of brain, unspecified site 191.9 Other malignant lymphomas of lymph nodes of head, face, and neck 202.81 Neoplasm of uncertain behavior of brain and spinal cord 237.5 Encephalitis and encephalomyelitis in viral diseases classified elsewhere — 323.01 (Code first underlying disease: 073.7, 075, 078.3) Myelitis in viral diseases classified elsewhere — (Code first underlying disease: 073.7, 075, 078.3) 323.02 Cerebral atherosclerosis — (Use additional code to identify presence of hypertension) 437.0 Cerebral aneurysm, nonruptured — (Use additional code to identify presence of hypertension) 437.3 Spina bifida with hydrocephalus, unspecified region 741.00 Hydromyelia742.53 Concussion with prolonged (more than 24 hours) loss of consciousness, 850.4 without return to pre-existing conscious level Terms To Know aneurysm. Circumscribed dilation or outpouching of an artery wall, often containing blood clots connecting directly with the lumen of the artery. atherosclerosis. Buildup of yellowish plaques composed of cholesterol and lipoid material within the arteries. body positions. Body positions for performing procedures include: Fowler's position: Position assumed by the patient when the head of the bed is raised 18 to 20 inches and the knees are elevated. Prone: Lying face down. Supine: Lying on the back. Trendelenburg position: Lying on the back with the supporting structure angled under the knees to lower the patient's head downward 30 to 40 degrees. bone conduction. Transportation of sound through the bones of the skull to the inner ear. cerebrospinal fluid. Thin, clear fluid circulating in the cranial cavity and spinal column that bathes the brain and spinal cord. closure. Repairing an incision or wound by suture or other means. cranial fossae. Three fossae (anterior, middle, and posterior) that form the floor of the cranial cavity (on the superior aspect of the base of the skull) and that provide a surface to support the various lobes of the brain. decompression. Release of pressure. dissection. Separating by cutting tissue or body structures apart. encephalitis. Inflammation of the brain, often caused by viral or bacterial infection. foramen. Natural opening or passage, especially one into or through a bone. lymphoma. Tumors occurring in the lymphoid tissues (usually malignant). neoplasm. New abnormal growth, tumor. occiput. Bone at the base of the skull that contains the foramen magnum, the opening in the bone that allows the spinal cord to join the brain. CCI Version 14.3 36000, 36410, 37202, 51701-51703, 61304-61305, 61535, 62140-62141, 62318-62319, 64415-64417, 64450, 64470, 64475, 90760, 90765, 90772, 90774, 90775, 92585, 95822, 95860-95861, 95867-95868, 95870, 95900, 95904-95920, 95925-95934, 95936-95937 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Medicare Edits Non-FacFac AssistFUDRVURVU d9051.8451.8461345 Medicare References: None CPT only © 2008 American Medical Association. All Rights Reserved.© 2008 Ingenix Coding Companion for Neurosurgery/Neurology140 — Skull/Brain Skull/Brain
  4. 4. 64752-64760 Transection or avulsion of; vagus nerve (vagotomy), transthoracic 64752 vagus nerves limited to proximal stomach (selective proximal vagotomy, 64755 proximal gastric vagotomy, parietal cell vagotomy, supra- or highly selective vagotomy) vagus nerve (vagotomy), abdominal64760 Explanation The physician transects or removes a portion of the vagus nerve. The vagus nerves supplies parasympathetic fibers to the heart and gastrointestinal tract. In 64752, the physician performs a left thoracotomy and locates the vagus nerve inferior to the cardiac branches. The nerve is transected to decrease gut motility and acid production in the stomach. In 64755, the physician makes a vertical midline epigastric incision and locates specific branches of the vagus nerve responsible for acid production in the stomach. In 64760, the physician makes a vertical midline epigastric incision and locates the vagus nerve. After locating the nerve or nerve branches, the physician transects them. The incision is sutured in layers. Coding Tips Vagotomy is frequently performed with procedures on the stomach and is often listed as an integral part of the service or as an in-addition-to code. In these instances, it should not be reported with 64752–64755. For vagotomy with a partial distal gastrectomy, see 43635. For vagotomy including a pyloroplasty, with or without gastrostomy, truncal or selective, see 43640; parietal cell (highly selective), see 43641. For laparoscopic approach, see 43651–43652. For injection, anesthetic agent, vagus nerve, see 64408. ICD-9-CM Procedural Other excision or avulsion of cranial and peripheral nerves 04.07 Vagotomy, not otherwise specified44.00 Truncal vagotomy44.01 Highly selective vagotomy44.02 Other selective vagotomy44.03 Anesthesia 0054064752 0079064755 0079064760 ICD-9-CM Diagnostic Malignant neoplasm of abdominal esophagus 150.2 Malignant neoplasm of liver, primary155.0 Malignant neoplasm of spleen, not elsewhere classified 159.1 Malignant neoplasm of cranial nerves192.0 Neoplasm of uncertain behavior of stomach, intestines, and rectum 235.2 Neurofibromatosis, Type 1 (von Recklinghausen's disease) 237.71 Neoplasm of uncertain behavior of other and unspecified parts of nervous system 237.9 Disorders of pneumogastric (10th) nerve 352.3 Chronic gastric ulcer without mention of hemorrhage, perforation, without 531.70 mention of obstruction — (Use additional E code to identify drug, if drug induced) Chronic or unspecified peptic ulcer, unspecified site, with hemorrhage, 533.40 without mention of obstruction — (Use additional E code to identify drug, if drug induced) Congenital tracheoesophageal fistula, esophageal atresia and stenosis 750.3 Injury to other specified cranial nerves951.8 Laparoscopic surgical procedure converted to open procedure V64.41 CCI Version 14.3 36000, 36410, 37202, 43635v, 43848, 51701-51703, 62310-62319, 64400-64435, 64445-64450, 64470, 64475, 64479, 64483, 64505-64530, 69990, 90760, 90765, 90772, 90774, 90775, 92585, 95822, 95860-95861, 95867-95868, 95870, 95900, 95904-95920, 95925-95934, 95936-95937 Also not with 64752: 64760v Also not with 64755: 43651-43652v, 44005, 44180, 44820-44850, 49000-49010, 49255, 64752v, 64760v Also not with 64760: 44005, 44180, 44820-44850, 49000-49010, 49255 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Medicare Edits Non-FacFac AssistFUDRVURVU d9012.8212.8264752 d9022.8422.8464755 d9012.0812.0864760 Medicare References: None ExtracranialNerves © 2008 IngenixCPT only © 2008 American Medical Association. All Rights Reserved. Extracranial Nerves — 397Coding Companion for Neurosurgery/Neurology
  5. 5. CPT only © 2008 American Medical Association. All Rights Reserved. © 2008 Ingenix Coding Companion for Neurosurgery/Neurology Evaluation and Management — 519 EvaluationandManagement Evaluation and Management This section provides an overview of evaluation and management (E/M) services, tables that identify the documentation elements associated with each code, and the federal documentation guidelines with emphasis on the 1997 exam guidelines. This set of guidelines represent the most complete discussion of the elements of the currently accepted versions. The 1997 version identifies both general multi-system physical examinations and single-system examinations, but providers may also use the original 1995 version of the E/M guidelines; both are currently supported by the Centers for Medicare and Medicaid Services (CMS) for audit purposes. Although some of the most commonly used codes by physicians of all specialties, the E/M service codes are among the least understood. These codes, introduced in the 1992 CPT® manual, were designed to increase accuracy and consistency of use in the reporting of levels of non-procedural encounters. This was accomplished by defining the E/M codes based on the degree that certain common elements are addressed or performed and reflected in the medical documentation. The Office of the Inspector General (OIG) Work Plan for physicians consistently lists these codes as an area of continued investigative review. This is primarily because Medicare payments for these services total approximately $29 billion per year and are responsible for close to half of Medicare payments for physician services. The levels of E/M services define the wide variations in skill, effort, and time and are required for preventing and/or diagnosing and treating illness or injury, and promoting optimal health. These codes are intended to represent physician work, and because much of this work involves the amount of training, experience, expertise, and knowledge that a provider may bring to bear on a given patient presentation, the true indications of the level of this work may be difficult to recognize without some explanation. At first glance, selecting an E/M code may appear to be difficult, but the system of coding clinical visits may be mastered once the requirements for code selection are learned and used. Types of E/M Services When approaching E/M, the first choice that a provider must make is what type of code to use. The following tables outline the E/M codes for different levels of care for: • Office or other outpatient services—new patient • Office or other outpatient services—established patient • Hospital observation services • Hospital inpatient services—initial care • Hospital inpatient services—subsequent care • Observation or inpatient care (including admission and discharge services) • Consultations—office or other outpatient • Consultations—inpatient The specifics of the code components that determine code selection are listed in the table and discussed in the next section. Before a level of service is decided upon, the correct type of service is identified. Office or other outpatient services are E/M services provided in the physician’s office, the outpatient area, or other ambulatory facility. Until the patient is admitted to a health care facility, he/she is considered to be an outpatient. A new patient is a patient who has not received any face-to-face professional services from the physician within the past three years. An established patient is a patient who has received face-to-face professional services from the physician within the past three years. In the case of group practices, if a physician of the same specialty has seen the patient within three years, the patient is considered established. If a physician is on call for or covering for another physician, the patient’s encounter is classified as it would have been by the physician who is not available. Thus, a locum tenens physician who sees a patient on behalf of the patient’s attending physician may not bill a new patient code unless the attending physician has not seen the patient for any problem within three years. Hospital observation services are E/M services provided to patients who are designated or admitted as “observation status” in a hospital. Codes 99218-99220 are used to indicate initial observation care. These codes include the initiation of the observation status, supervision of patient care including writing orders, and the performance of periodic reassessments. These codes are used only by the physician “admitting” the patient for observation. Codes 99234-99236 are used to indicate evaluation and management services to a patient who is admitted to and discharged from observation status or hospital inpatient on the same day. If the patient is admitted as an inpatient from observation on the same day, use the appropriate level of Initial Hospital Care (99221-99223). Code 99217 indicates discharge from observation status. It includes the final physical examination of the patient and instructions and 04 ATNN EM .fm Page519 Friday,Novem ber21,2008 5:04 PM

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