Category: Neurosurgery

Time Reporting for E/M Levels
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Time Reporting for E/M Levels

November 16, 2023 Question: Is it best practice to bill 99202-99215 based on time only? Answer: CPT Codes 99202 to 99215, history and physical examination will no longer be a key factor in determining your level of coding. Instead, coding will be dependent on: Levels of medical decision making applied during the service OR Total...

Coding Percutaneous Rods and Screws: Part 2
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Coding Percutaneous Rods and Screws: Part 2

October 19, 2023 Question: What if we the neurosurgeon places percutaneous screws and rods (no posterior fusion/bone graft) as the sole treatment for a vertebral fracture. Do we code the regular posterior instrumentation codes, for example +22840 or +22842? Answer: Unfortunately, no. Placement of percutaneous screws and rods as the sole procedure must be reported...

Placement of Percutaneous Posterior Instrumentation (Rod and Screws) Part 2
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Placement of Percutaneous Posterior Instrumentation (Rod and Screws) Part 2

August 3, 2023 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...

Placement of Percutaneous Posterior Instrumentation (Rod and Screws) Part 1
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Placement of Percutaneous Posterior Instrumentation (Rod and Screws) Part 1

July 20, 2023 Question: I placed posterior percutaneous screws and rods without an arthrodesis, the day after an ALIF. Should I bill 22842, it was segmental, 3-6 segments spanned, and a 58 modifier? Answer: Code 22842 is for open segmental instrumentation. Most importantly, it is an add-on code and can only be reported with a...

Venous Stenting for Intracranial Hypertension (ICH)
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Venous Stenting for Intracranial Hypertension (ICH)

June 8, 2023 Question: What are the most appropriate codes for venous stenting for a patient with intracranial hypertension? Answer: There is no specific CPT code for intracranial venous stenting. An unlisted code 64999 should be reported in addition to second order venous catheterization, 36012 and the venogram , most typically 75870, venography superior sagittal...

Facet Fusion
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Facet Fusion

May 25, 2023 Question: The neurosurgeon documents a placing a cervical “facet implant or intrafacet implant “ with bone graft. Is this coded as 22600, cervical arthrodesis? Answer: No. This is coded with a Category III code, as shown below: Facet Wedge or Dowel Arthrodesis (Intrafacet Implant) Placement of a posterior intrafacet implant(s), unilateral or...

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