Neurosurgery Coding Alert

You know how coding guidelines restrict your ability to report multiple codes during operative sessions? That isn't the case for cranial stereotactic radiosurgery, but you still need to know what codes to report and when. Use these four steps to ensure correct code selection every time.

CPT 2009 introduced a new code family for stereotactic radiosurgery. The number and type of lesions treated differentiate the codes:

• 61796 -- Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 simple cranial lesion

• +61797 -- each additional cranial lesion, simple (List separately in addition to code for primary procedure)

• 61798 -- 1 complex cranial lesion

• +61799 -- each additional cranial lesion, complex (List separately in addition to code for primary procedure).

Your surgeon's documentation will point you toward "simple" or "complex." Complex lesions include those that are adjacent (5 mm or less) to the optic nerve/optic chasm/optic tract or within the brain stem. Certain typesof lesions are automatically considered complex (such as schwannomas, arterio-venous malformations, pituitary tumors, glomus tumors, pineal region tumors, and cavernous sinus/parasellar/petroclival tumors).

Simple cranial lesions are less than 3.5 cm in maximum dimension that do not meet CPT's definition of a complex lesion.

Tip: The surgeon might choose to treat the same lesion during more than one session over the course of care, but that doesn't mean you automatically report everything multiple times. CPT directs you to only submit 61796 or61798 once per course of treatment, regardless of how many sessions the surgeons require to treat the lesion.

Once the surgeon treats multiple lesions, you'll add either +61797 or +61799 to your claim, based on whether the lesions are simple or complex. You can include either of these add-on codes for a maximum of five lesions treated during the session.

Over the limit: How do you report the service if the surgeon treats more than five lesions? You don't, according to AMA instructions. Even if your physician treats more than five lesions on a date of service, you stop at reporting one primary code (61796 or 61798) and four units of the appropriate add-on code.

"Don't report +61797 or +61799 more than four times for an entire course of treatment, regardless of the numbers of lesions your neurosurgeon treats," explains Marianne Schipper, CPC, a spine, brain, and endovascular coding specialist at Barrow Neurosurgical Associates in Phoenix, Ariz.

Linear accelerator based radiation is frameless. Many other treatment systems, however, are frame-based -- which means you'll add another code to your claim.

If the surgeon uses a frame-based system, be sure to include +61800 (Application of stereotactic headframe for stereotactic radiosurgery [List separately in addition tocode for primary procedure]) on your claim, Schipper says.

Heads up: Sometimes the neurosurgeon applies the frame but doesn't participate in the rest of the radiosurgery procedure, says Deborah Messinger, CPC, a coding specialist with Massachusetts General Physicians Organization in Charlestown. In that case, you report 20660 (Application of cranial tongs, caliper, or stereotactic frame, including removal [separate procedure]) instead of +61800.

Several editions of the national Correct Coding Initiative (CCI) edits during the past year included restrictions pertaining to stereotactic radiosurgery.

For example, 61796 and 61798 include injections normally reported with +96376 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; each additional sequential intravenous push or the same substance/drug provided in a facility [List separately in addition to code for primary procedure]).

For the latest CCI edits and explanations, check out the coding toolkit at https://www.aapc.com/codes/.