# Sterotactic biopsy code 61750



## Tomeka (May 3, 2010)

Is it appropriate to bill sterotactic biopsy code (61750) when performing a Craniectomy for excision of Brain tumor(61510)?


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## RebeccaWoodward* (May 3, 2010)

Yes... 

(Per CCI edits and the Neurosurgery Coding Companion)


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## Tomeka (May 3, 2010)

Thanks Rebecca,

I have been billing this for one of my physician and have been recieving payment. However, I have two other physicians that was questioning the 61750 as they were considering this as double dipping. I just needed more amunition to present to them as we would not like to leave any money on the table.


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## RebeccaWoodward* (May 3, 2010)

Hmmm...

I'll go through my other material and see if I can produce something a little more tangible.  

I'll let you know.


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## RebeccaWoodward* (May 3, 2010)

Although CCI edits and the manual I referred to indicate that these two services aren't bundled...I am having 2nd thoughts.

61750=A special ring is attached to the skull before the procedure, keeping the patient's head perfectly still. The physician uses MRI or CT scans to map out the procedure and determine where exactly in the brain the procedure will be performed. The physician then drills a small hole in the skull. Next, the physician uses a needle to take a tissue sample for examination and analysis, draw fluid from a lesion, or remove a lesion inside the brain.

61510=The physician removes a flap of bone from the skull to access and remove a brain tumor located underneath. The flap of bone is removed with the help of a hand-operated drill, and is located above the membrane that separates the upper and lower lobes of the brain. Code 61512 if the tumor removed is a slow-growing tumor located in one of the membranes which line he brain.

These appear to be *two, distinct procedures to me*.  Below is an excerpt from Neurosurgery Coding Answer Book...

There are several different approaches that may be employed by the surgeon in order to gain access to intracranial structures, and the CPT manual includes different ranges of codes for each. Additionally, specific codes are available to report surgery that employs specialized techniques such as stereotaxis, as well as surgery in particularly difficult and/or risky locations such the base of the skull. Therefore, whenever a surgical report identifies a stereotactic or neuroendoscopic method used and/or surgery directed toward the base of the skull, you should consider the specific codes that the CPT manual has included to report these services:

*Stereotactic surgery* (61720-61795, 61863-61868) 
Skull base surgery (61580-61616) 
Neuroendoscopy 

If one of the *specialized surgeries identified above* is not involved, there are *three basic approaches* used to gain access to the inside of the skull:

Twist drill 
Trephination/burr holes 
*Craniotomy/craniectomy *

It appears that your selection of code would be based on "either/or" but not both unless you are performing these two procedures at different sites of the skull and I don't know how common that is.

If you look at 63030 and 63056 (an example), you will see that there aren't any edits in place for these two procedures; however, coding 63030 and 63056 for the same disc is considered double billing. Both of these procedures have different approaches and would not be feasible through the same incision. Why did I mention this?  CCI edits aren't an exact science.  As more and more CPT codes/groups get submitted for utilization review, we'll see these type of edits corrected.

Anyone else?


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