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Coding for Trigeminal Neuralgia #1
A retrosigmoid craniotomy was performed with microvascular decompression of the 5th nerve. The diagnosis was Trigeminal Neuralgia. How is this coded?
Question:
A retrosigmoid craniotomy was performed with microvascular decompression of the 5th nerve. The diagnosis was Trigeminal Neuralgia. How is this coded?
Answer:
This procedure is reported with code 61458,Craniotomy, suboccipital, for exploration or decompression of cranial nerves.
*This response is based on the best information available as of 10/06/22.
Coding a Decompressive Craniectomy
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?
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
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?
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
If the exposure is thoracic, for example in a thoracic corpectomy, and the documentation states a costotransversectomy was performed, can that be billed separately?
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
How do you report a spinal procedure for example, arthrodesis or laminectomies when two spinal are involved. For example., both thoracic and lumbar spine?
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
Can code 20680, removal of implant, be used for removal of a previously placed intervertebral device, such as a PEEK cage?
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.