Neurosurgery Coding Alert

Question: When the epileptogenic focus (the tissue of the brain from which epileptic seizures originate) is removed for seizures and a lobectomy is performed at the same time, can I bill for both procedures? If the brain lab frameless is also used, should it be coded 61795 or 61795-26?

California Subscriber

Answer: Carriers may reject lobectomy code 61538 (craniotomy with elevation of bone flap; for lobectomy with electrocorticography during surgery, temporal lobe) or 61539 ( for lobectomy with electrocorticography during surgery, other than temporal lobe, partial or total) billed in conjunction with 61534 ( for excision of epileptogenic focus without electrocorticography during surgery) for several reasons. First, 61534, 61538 and 61539 all branch from 61533, the same root code. Each of the code definitions begins with craniotomy with elevation of bone flap. Billing two at once may cause the carrier to believe that you are attempting to get reimbursed twice for a single service.

Second, they may argue that in many cases the seizure focus is excised as a result of the lobectomy. Third, codes 61538 and 61539 specifically state with electrocorticography during surgery while 61534 states without electrocorticography during surgery.

A major consideration in coding this scenario is whether or not the neurosurgeon had to perform additional work to excise the seizure focus in addition to performing the lobectomy. If one craniotomy was performed during the seizure focus excision and another completely separate craniotomy was performed during lobectomy, you should be able to get paid for both. If the neurosurgeon excised the seizure focus at a different location through the same craniotomy, it may be possible to make a case for an increased charge, if not separate charges. Thus, it may be warranted to append the -22 modifier (unusual procedural services) to the lobectomy code (61538 or 61539) and charge an additional amount accordingly. If you bill 61534 in addition to the lobectomy code (61538 or 61539), consider appending modifier -52 (reduced services) to 61534 to indicate that you are billing additionally for the extra work relating to the excision of the seizure focus only and not for two craniotomies. If the epileptogenic focus is excised in continuity with the lobectomy and does not add significant time or effort, only the lobectomy should be billed.

The -26 modifier (professional component) separates the technical and professional components of a code. There is no separate technical component associated with 61795 (stereotactic computer assisted volumetric [navigational] procedure, intracranial, extracranial, or spinal [list separately in addition to code for primary procedure]), so modifier -26 is not needed. However, recent Correct Coding Initiative (CCI) edits have bundled 61795 into a number of procedure codes. (See the February 2001 issue of Neurosurgery Coding Alert for a full listing of these codes before billing 61795.)

Note: HCFAs CCI edits are not available as a free download. They must be purchased from National Technical Information Service (NTIS), a division of the U.S. Department of Commerce. You may order the edits by phone at 1-800-363-2068 or 1-703-605-6060, or via the Internet at http://www.ntis.gov/product/correct-coding.htm. Several versions are available. Ask the NTIS representative to explain your options or visit the Web site to choose the version that best fits your needs.