Next question is skull base surgery codes and modifier 51.
Laura asks: How do you accurately code surgery of the skull base.
Are your definitive codes considered to be a lesser code and is modifier 51 needed?
Excellent question.
This is a great question.
So lets go to my answer page.
What I did was a kind of scan of the code, I said bring it with me to the hotel because
I don’t have my document camera and this is basically page 312 and these are the guidelines.
So the first thing we are going to answer is about the modifier 51 if we need it or
not.
Surgery of the skull base, if you picture where your head connects to your neck and
if there was a lesion in that base of the skull, how would you get to it, its not like
a lesion on the arm or the back where its very easy to access.
So since its so complicated you really need a surgeon that has a certain skill set to
be able to do that and then another surgeon normally is the one that takes care of the
lesion or tumor or whatever it is that they are trying to remove.
So, if you look at the guidelines it talks about approach procedures and definitive procedures.
Approach procedure is described according to anatomical area involved and the definitive
procedure describes the repair biopsy, resection or excision.
So normally, according to guidelines, the surgical management of lesions involving the
skull base often requires the skills of several surgeons of different surgical specialties
working together or in tandem.
These operations usually are not staged because the need for definitive codes, obviously they
are going to get the area exposed, they need to go in and take care of the lesion.
So, there are two codes.
Let me just skip down a little bit to the screen shot of the actual code.
So here you can see approach procedures, and this first one, 61580, craniofacial approach.
That’s one type, the anterior approaches, the middle approaches and the posterior approaches.
Then you have the definitive procedure.
You can see my notes here, the definitive procedure must relate or link to the approach
procedure.
So, if you are doing base of anterior craniofacia for your definitive procedure you shouldn’t
be doing an anterior craniofacia approach.
So you can see how there are separate codes for the approach and separate codes for the
definitive procedure.
So, the question is, do we need to use modifier 51, if you have two different surgeons doing
a piece themselves, one does the approach, and one does the definitive procedure, they
know, you don’t need modifier 51.
However if one of the surgeons, these are from the guidelines, performs more than one
procedure i.e., the approach and the definitive, then both codes are reporting adding modifier
51, right there in the guidelines, secondary additional procedure.
So I suspect you already knew that but you were just confirming it and then what you
want to know is…ok when we have modifier 51 we normally put it on the lesser valued
code because you pay 100% of the first surgical code and then 50% of the subsequent ones and
51 would do that so how do you know the value because her other part of her question was
“are the definitive codes considered to be lesser codes so lets take a look.
I went to findacode again and I just used an approach code 61580 and
a definitive code 61600 and sure enough the approach code has a higher RVU because if
you think about it, its actually harder to get the area exposed and get to it than it
is to go excise the tumor.
So, how did I know that?
I went to the MCCI edits validator and it gave me these two things, I use that not because
I was checking MCCI edits but because I knew it would give me both codes like this I can
see the descriptions stacked on top of each other and here are the RBUs.
The craniofacial approach has a RB of 78.77 and the definitive Procedure, the resection,
has a RVU of 67.89.
Both are very high because after all, this is brain surgery so that’s how this breaks
down.
My little plug at the end is if you need help understanding the CPT modifiers better, consider
getting our on demand CEU Webinar called modifier its all about the money, I will show you the
link.
If you go to the coding certification.org website and you click on medical coding webinars,
it will take you here.
So, we can see here that its $67 for the online only and $87 for DVD and online and its worth
1.5 CEUs for those of you that are certified consider getting that to add to your arsenal.
Also, we have hot, hot, hot off the press is our new give-a-way which is the modifier
decision grid tool, its actually a part of this modifier, its all about the money presentation.
I taught this, in 2000 at the AAPC conference and taught it for three or four years after
that.
This little two-page tool was very popular and people were like “I love this I’m
going to laminate it, I’m going to stick it up on my desk” so definitely check that
out, just go to coding certification.org and you will see this graphic on the right on
the sidebar just click it and you can get it for free, download it, its two-page pdf.
Get more cpc exam tips, coding certification training, and ceu credits.
Go to www.codingcertification.org