Neurosurgery Coding Alert

Avoid confusing brachytherapy with carmustine disks

If your surgeon places intracavitary chemotherapy disks in the patient's skull following removal of a brain tumor, don't forget that you can report this procedure separately using 61517.

Earn Your Surgeon an Extra $53

Reported properly, 61517 will reimburse your surgeon an additional 1.38 work relative value units (RVUs). Based on national Medicare average payments, this equals about $53 that goes directly to the surgeon.

Treat 61517 as an Add-on Code

Because +61517 (Implantation of brain intracavitary chemotherapy agent [list separately in addition to code for primary procedure]) is an add-on code, you must claim an initial, primary procedure before reporting 61517, says Anita L. Carter, LPN, CPC, an instructor at A+ Medical Management and Education, a school for billing and coding in Absecon, N.J.
 
As a primary procedure, you must select either 61510 (Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except meningioma) or 61518 (Craniectomy for excision of brain tumor, infratentorial or posterior fossa; except meningioma, cerebellopontine angle tumor, or midline tumor at base of skull), according to CPT instructions.
 
Both 61510 and 61518 describe brain tumor excision via craniectomy. After the surgeon exposes and removes the tumor, he places the chemo disks at the tumor's former site. The disks, known commonly by the trade name Gliadel Wafers, contain the chemotherapeutic drug carmustine (BCNU). The wafers dissolve over two to three weeks and deliver BCNU in high concentrations to treat remaining diseased tissue and inhibit further tumor development.

Steer Clear of Brachytherapy

A common mistake you should avoid is treating Gliadel Wafers as a form of brachytherapy.
 
Brachytherapy describes the placement of a radiation source next to or inside an affected body part. Although this does seem to describe the intracavitary disks, the CPT codes for brachytherapy (77781-77784) specify the use of catheters or "source positions" to deliver radiotherapy agents to the tumor site.
 
Prior to the introduction of 61517, "the only codes available for reporting cerebral chemotherapy described chemotherapy when administered intravenously, subarachnoid or intraventricular via a subcutaneous reservoir," none of which described placement of intra-cavitary wafers, the AMA noted in CPT Changes 2003.