Neurosurgery Coding Alert

Question: Our surgeon used ultrasound localization during a posterior fossa craniectomy for resection of cerebellar brain tumor. I know the craniectomy is 61518, but may I report the ultrasound?

Neurosurgery Discussion Group Participant

Answer: The American Association of Neurological Surgeons (AANS) recommends against separately reporting intraoperative ultrasound because the surgeon cannot simultaneously operate and interpret an ultrasound (or, similarly, conduct intraoperative monitoring). The AANS recommendations, although not binding, are reasonable and medically sound.

Note, however, that the national Correct Coding Initiative does not forbid reporting 76986 (Ultrasonic guidance, intraoperative) with craniectomy codes such as 61518 (Craniectomy for excision of brain tumor, infraten-torial or posterior fossa; except meningioma, cerebello-pontine angle tumor, or midline tumor at base of skull), and neither do CMS guidelines. Theoretically, at least, the surgeon could report 76986 and 61518 together, for instance, but he or she would have to provide documentation to justify the billing and prove that both services were properly rendered.

For example, if the surgeon stops operating and uses the ultrasound to locate the tumor (as would a radiologist or neurologist, who would also charge separately for the service) before proceeding, he or she might make the case for separate payment. If documentation supports reporting 76986 in addition to the surgical procedure, you must attach modifier -26 (Professional component) to the ultrasound code. If you bill, be prepared to defend your claim: The payer will likely reject it.