Neurosurgery Coding Alert

Question: Code 61862 is defined as a singular procedure. When the neurosurgeon performs this procedure on the left side and then again on the right side, are the following codes correct and can they be used with modifier -50? 61862-LT; 61862-59-51-RT; 61885-51-LT; 61885-59-51-RT.

Kelly Kellen
Tucson, Ariz.

Answer: Tammy Chidester, CPC, billing supervisor at Upshur Medical Management Services Inc. in Buckhannon, W.Va., says that according to the Medicare Fee Schedule Database, 61862 (twist drill, burr hole, craniotomy, or craniectomy for stereotactic implantation of one neurostimulator array in subcortical site [e.g.,thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray]) and 61885 (incision and subcutaneous placement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array) should not be billed with modifier -50 (bilateral procedure).

Modifier -59 should be used to indicate that a procedure or service is distinct from other services performed on the same day, and to identify procedures that are not normally reported together but are appropriate under the circumstances.

According to CPT 2000, this may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury, not ordinarily encountered or performed on the same day by the same physician. This should be used only if no other more descriptive modifier is available and the use of modifier -59 best explains the circumstances. In this case, modifier -59 would indicate a separate location for the second electrode in a way that the -51 modifier (multiple procedures) would not. The -LT (left) and -RT (right) modifiers often give the payer a better picture of why the two procedures are being billed together.

If separate generators are inserted and connected, codes 61885-51-LT and 61885-59-RT should be submitted. If a single generator is attached to both electrode arrays, the single code 61886-51 should be used instead.