Neurosurgery Coding Alert

Question: Our surgeon performed cyberknife on three different days for multiple intracranial metastases. The insurance is denying as inclusive. Is there an appropriate modifier we should be using?

New York Subscriber

Answer: There is insufficient information provided to allow for accurate coding. Even though there were multiple sessions (days), there is a limit of reporting treatment of five lesions altogether. Since metastases are typically simple lesions (although the location may warrant choice of a complex code), the first lesion would be reported with 61796 (Stereotactic radiosurgery [particle beam, gamma ray, or linear accelerator]; 1 simple cranial lesion) and up to four additional lesions would be reported with the add-on code 61797 (Stereotactic radiosurgery [particle beam, gamma ray, or linear accelerator]; each additional cranial lesion, simple [List separately in addition to code for primary procedure]).