ICP Monitor and EVD Placed on Both Sides

Question:

We placed an ICP monitor on the left side of the cranium and a right ventriculostomy, both using the twist drill. We know to use CPT 61107 but wondered about using modifier 50 (bilateral procedure). Thoughts?

Answer:

Medicare does not recognize modifier 50 on 61107, though some payors might or may even recognize using HCPCS II modifiers RT (right) and LT (left). We suggest you report 61107 and 61107-59 (or modifier XS) just to be clear that the same CPT code was performed on either side of the head.

*This response is based on the best information available as of 10/29/20.

Elective Cranioplasty after Emergent Hemicraniectomy

Question:

I did an emergency craniectomy on a stroke patient 4 months ago. It is now time to reconstruct the defect and I’ll be doing that by placing some mesh and screws with Methyl methacrylate. Should I be using the 62140/62141 code series?

Answer:

Actually, CPT considers what you are doing to be “Replacement of bone flap or prosthetic plate of skull” which is 62143. You would still use 62143 even if you reconstructed the defect with the patient’s own bone flap that was stored at the bone bank or with an alloplastic implant designed for the patient.

*This response is based on the best information available as of 10/15/20.

Post-Op Anterior Cervical Wound Abscess

Question:

How do I code for repair of wound dehiscence with deep abscess status post ACDF (anterior cervical discectomy, decompression and fusion)? I looked at 22010 but that’s for a posterior procedure.

Answer:

Take a look at 21501 (Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax) to see if it meets your needs.

*This response is based on the best information available as of 10/1/20.

VP Shunt Re-programming During a Global Period

Question:

What if we have to re-program a VP shunt during the global period because the settings need to be adjusted – can we bill for it or is it considered part of the 90-day post-operative global period?

Answer:

Good Question:. The initial shunt programming, at the time of insertion, is included in the shunt placement code (e.g., 62223). However, subsequent shunt re-programming is not included. Therefore, you may separately report 62252 (Reprogramming of programmable cerebrospinal shunt) for the shunt re-programming even if you are in a global period. You may need to append modifier 58 to 62252 as it would be anticipated re-programming is needed if the patient’s condition changed.

*This response is based on the best information available as of 8/20/20.

Spine Fracture Repair and Decompression

Question:

How do I code for repair of a C6-7 fracture/dislocation where I did a laminectomy for decompression to repair the fracture as well as an arthrodesis?

Answer:

You’ll use CPT 22326 (Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; cervical) for the open cervical fracture/dislocation repair. Additionally, you may report codes for the arthrodesis (e.g., 22600), instrumentation (e.g., +22840) and bone graft (e.g., +20936). Do not separately report a decompression code (e.g., 63001) for the laminectomy at the same level of the fracture repair procedure (22326).

*This response is based on the best information available as of 8/6/20.

Removal of sEEG Electrodes

Question:

I placed subdural stereo-EEG electrodes for epilepsy monitoring. What is the code for removal of these electrodes? I’ve been billing 61880 for removal of each electrode up to 10 or 13 units depending on how many electrodes I remove. My new coder said she’s not sure we are using the correct code. Please help.

Answer:

We agree with your coder and there are actually two coding issues here. First, the CPT descriptor for 61880 says “Revision or removal of intracranial neurostimulator electrodes”. Notice the code is specifically for removal of neurostimulator electrodes, not epilepsy monitoring electrodes.

Second, note the word “electrodes” is plural, meaning more than one electrode. So not only are you using an incorrect code but you are also reporting an incorrect number of units.

There really isn’t a good code for removing subdural stereo-EEG electrodes unless you’re lifting a bone flap (61535). In the absence of a craniotomy for removal of the electrodes, you could sum the length of the wound repairs and report a wound repair code (e.g., simple repair 12001) or use an unlisted code (64999).

*This response is based on the best information available as of 7/9/20.