Neurosurgery Coding Alert

Question: If a neurosurgeon uses fluoroscopic guidance during an endonasal transsphenoidal resection of a pituitary tumor, should I code for the fluoroscopic guidance or only for the endonasal, 61548?

Wyoming Subscriber

Answer: Neurosurgeons may code for fluoroscopic guidance in addition to any procedure that does not include it in the description.

Because the definition for 61548 (hypophysectomy or excision of pituitary tumor, transnasal or transseptal approach, nonstereotactic) does not include fluoroscopic guidance, it may be coded in addition to the procedure using 76000 (fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) with modifier -26 (professional component) or 76001 (fluoroscopy, physician time more than one hour, assisting a non-radiologic physician [e.g., nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy]) with modifier -26, depending on the time.