Neurosurgery Coding Alert

Question: What is the optimal coding for resection of a pineal tumor via a suboccipital craniectomy (supracerebellar infratentorial approach) with microdissection?

California Subscriber

Answer: Use 61518 (craniectomy for excision of brain tumor, infratentorial or posterior fossa; except meningioma, cerebellopontine angle tumor, or midline tumor at base of skull) for the resection and 69990 (use of operating microscope [list separately in addition to code for primary procedure]) for microdissection.

Some neurosurgery coders have been reporting denials for 69990. This may stem from carriers still applying payment guidelines for 61712, the now-deleted code for microdissection. Medicare and most third-party payers covered 61712 for a very specific and limited list of procedure codes.When it was replaced with 69990, the CPT definition was revised to indicate that microdissection is often performed and should be reported with a much broader range of services. If you are experiencing denials of 69990, check with your carrier to verify that they are aware of the broader spectrum of acceptable uses for this code.