Neurosurgery Coding Alert

Question: The application of tongs (20660) often is not paid separately. Insurance companies tell us that this service is included in the payment of the primary surgical procedure. Which codes are not bundled with CPT code 20660?

Mark Stern, MD
Escondido, Calif.

Answer: The term separate procedure indicates that the code should not be billed when the service is performed in conjunction with or as a component of a more comprehensive procedure, says Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C. In addition, CPT directs that you would not bill for external fixation separately when that fixation is already a part of that procedure.

Unfortunately, there is no definitive list of codes that may be used with 20660 (application of cranial tongs, caliper, or stereotactic frame, including removal [separate procedure]). This code indicates a procedure that generally is used for one of two purposes: as a frame of reference for stereotactic surgery, or for cervical fracture stabilization. It is now bundled into almost all stereotactic procedure codes (e.g., 61793, stereotactic radiosurgery [particle beam, gamma ray or linear accelerator], one or more sessions; 61751, stereotactic biopsy, aspiration, or excision, including burr hole[s], for intracranial lesion; with computerized axial tomography and/or magnetic resonance guidance) although some payers other than Medicare will still allow it. It is used almost exclusively for the repair.

Whenever deciding whether to bill 20660, consider if this type of fixation device is common for this type of repair or procedure. If so, 20660 would not be billed. It would be rare to use this code unless the frame is placed and no other treatment is performed.