Neurosurgery Coding Alert

Question: Recently I received an operative report in which the surgeon describes implanting a -Gliadel Wafer- in the skull following excision of a brain tumor. I-m unfamiliar with this device. Is there a code for this, or do I have to rely on an unlisted-procedure code?

Nevada Subscriber

Answer: Gliadel Wafer is the trade name for dime-sized discs containing the chemotherapeutic drug carmustine (BCNU). The surgeon may implant as many as eight wafers at the tumor excision site. The discs will dissolve to deliver BCNU in high concentrations.

In 2003, CPT added +61517 (Implantation of brain intracavitary chemotherapy agent [list separately in addition to code for primary procedure]) to report separate placement of these discs.

Note that 61517 is an add-on code describing implantation of the chemotherapy agent only, and that it must accompany 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). Both 61510 and 61518 describe brain tumor excision via craniectomy. After the surgeon exposes and removes the tumor, he may place the chemo discs at the tumor's former site.

When reported properly, 61517 will reimburse your surgeon an additional 1.38 work relative value units. Based on national Medicare average payments, this equals about $52 in additional reimbursement.