Neurosurgery Coding Alert

Question: Can we bill for our neurosurgeon’s work in stereotactic radiosurgery with 61796–61799? A radiation oncologist was a co-surgeon for this procedure.

Answer: The Medicare physician fee schedule indicates that modifier 62 (Two surgeons) is not appropriate for 61796 (Stereotactic radiosurgery [particle beam, gamma ray, or linear accelerator]; 1 simple cranial lesion) – 61799 (Stereotactic radiosurgery [particle beam, gamma ray, or linear accelerator]; each additional cranial lesion, complex [List separately in addition to code for primary procedure]) by placing a “0” in the co-surgeon column.

Your neurosurgeon may be partly supporting the procedure. You will have to clearly specify what your surgeon supported. For example, if your surgeon uses a frame-based system, be sure to include +61800 (Application of stereotactic headframe for stereotactic radiosurgery [List separately in addition tocode for primary procedure]) on your claim.

Alternatively, you may read that your neurosurgeon applied the frame but did not participate in the rest of the radiosurgery procedure. In that case, you report 20660 (Application of cranial tongs, caliper, or stereotactic frame, including removal [separate procedure]) instead of +61800.

Your radiation oncologist may bill the services with code 77432 (Stereotactic radiation treatment management of cranial lesion[s] [complete course of treatment consisting of 1 session]) and this covers services like clinical treatment planning, administration of treatment, and overall case management.