Neurosurgery Coding Alert

You can report 61793 more than once for multiple lesions 

If you're reporting stereotactic radiosurgery, also called gamma knife surgery, you must be careful not to confuse the roles of the neurosurgeon and the radiation oncologist. To avoid confusion, don't report any 70000-series codes for the neurosurgeon, experts say.
 
Follow these three tips for optimum reimbursement of the codes you do report.

1. Stick With 61793

Neurosurgeons reporting stereotactic surgery will normally bill a single code: 61793 (Stereotactic radiosurgery [particle beam, gamma ray or linear accelerator], one or more sessions). You should use this same code for brain or spinal stereotactic surgery, says Jim Hugh, vice president of American Medical Accounting & Consulting in Atlanta.

The radiation oncologist will not report 61793, but she may bill for planning, management and/or dosimetry.

2. Bundle 61795 and 20660

As a corollary to tip 1, you should not bill +61795 (Stereotactic computer-assisted volumetric [navigational] procedure, intracranial, extracranial or spinal [list separately in addition to code for primary procedure]) and 20660 (Application of cranial tongs, caliper or stereotactic frame, including removal [separate procedure]) in addition to 61793 - at least for Medicare payers or others that follow National Correct Coding Initiative guidelines. Although some third-party payers may allow you to report navigation or placement of the stereotactic frame separately, the NCCI bundles 61795 and 20660 into 61793, says Eric Sandhusen, CPC, CHC, director of compliance for the Columbia University department of surgery.

3. Multiple Lesions = Multiple Codes

 When the surgeon treats multiple lesions using 61793, you may report multiple code units. This is great news for neurosurgeons and represents a recent change in AMA policy.

The AMA initially instructed that surgeons should report 61793 only once per session, no matter how many lesions the patient might have, according to the May 2003 CPT Assistant. But, after discussions with the American College of Neurosurgery, the AMA reversed course in the April 2004 CPT Assistant.

The AMA now says that surgeons can report 61793 twice if the patient had two lesions, one on the right side and one on the left side of the brain. "Code 61793 is valued for a single metastatic lesion," and multiple lesions require "significantly more physician work" on radiosurgical planning and treatment, the AMA admitted.

Modifier tip: The AMA also noted that when billing multiple units of 61793, the coder should attach either modifier -59 (Distinct procedural service) or -51 (Multiple procedures), depending on payer requirements, to verify that the surgeon treated two separate lesions.