Neurosurgery Coding Alert

Question: How should I report stereotactic brachytherapy?

Massachusetts Subscriber

Answer: During stereotactic brachytherapy, a neurosurgeon and radiation oncologist often work side-by-side to implant the radioactive seeds. Because each physician performs a separate portion of the procedure, the neurosurgeon and oncologist should not bill as co-surgeons. Rather, each surgeon should bill only for his or her portion of the surgery. The neurosurgeon reports 61770 (Stereotactic localization, including burr hole[s], with insertion of catheter[s] or probe[s] for placement of radiation source). A radiation oncologist approved for handling radioactive substances in a clinical setting will implant the seeds and bill separately for that service.

Prior to surgery, the neurosurgeon, working with an oncologist, may spend a great deal of time determining the proper course of treatment. Such planning for brachytherapy treatment is coded 77261-77263 (Therapeutic radiology treatment planning ), as appropriate. Generally, the highest level of complexity (i.e., 77263) will be indicated. To demonstrate the necessity of the neurosurgeon's involvement in the planning, the medical record should include interpretation of results of special testing, tumor localization, treatment volume, treatment time/dosage, choice of treatment modality, determination of number and size of ports, and selection of appropriate devices, as recommended by CPT.

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno.