Neurosurgery Coding Alert

Question: Our physicians apply the head ring for radiosurgery and perform the mapping and localization of the tumor. They do not administer the radiation. We are billing 20660 but have been advised that 61793 would be better. How should we report this?

Michigan Subscriber

 
Answer: You may bill 61793 (stereotactic radiosurgery [particle beam, gamma ray or linear accelerator], one or more sessions) only if the physician provides all portions of treatment, including administration of the radiation (which cannot be billed separately). Transamerica Occidental Life, a California Part B Carrier, for instance, specifies in its local medical review policy on stereotactic radiosurgery procedures, CPT 61793 ... is an appropriate billing for the entire course of treatment and should not be billed for each fraction of treatment.
 
Also, if the physician administering the radiation bills 61793, separately reporting 20660 (application of cranial tongs, caliper, or stereotactic frame, including removal [separate procedure]) or 61795 (stereotactic computer assisted volumetric [navigational] procedure, intracranial, extracranial, or spinal [list separately in addition to code for primary procedure]) -- both of which are bundled into 61793 -- may be seen as double-dipping, or unbundling.  
 
However, some payers do not observe national Correct Coding Initiative bundling edits. Check if non-Medicare payers will allow separate payment for these, especially because Medicare never adjusted the payment amount for 61793 when it changed the bundling edits to include these services.

Note: Some insurers may accept the claim if each physician reports 61793 with modifier -52 (reduced services) appended. However, this is unlikely. Check with your carrier before applying this coding, and be sure to get its recommendations in writing.