Neurosurgery Coding Alert

Question: Our local Medicare carrier denies 61795 if it is not used with 61793. Is this correct?

Idaho Subscriber

 
Answer: Neither CPT nor Medicare policy limits the use of add-on code 61795 (stereotactic computer assisted volumetric [navigational] procedure, intracranial, extracranial, or spinal [list separately in addition to code for primary procedure]) to claims also listing 61793 (stereotactic radiosurgery [particle beam, gamma ray or linear accelerator], one or more sessions). The national Correct Coding Initiative (CCI) bundles the procedure to a number of codes, including 61720, 61735, 61750, 61751, 61760, 61770, 61790, 61791, 61793, 61862, 62201, 63600 and 63615. These edits include a 0 indicator.
 
For example, if 61795 is performed with any of the above procedures, it cannot be billed separately. The edits make clear, however, that 61795 may be used with codes other than 61793 (although it may not always be separately billable). Code 61795 is separately billable when used with any navigation procedure included in CCI, such as craniectomy and tumor excision (61510).
 
If you have used the code correctly, appeal your carriers decision and ask for a justification. Reference the CCI and the lack of specific instructions in CPT limiting the use of 61795 to 61793 as evidence that the code applies in other circumstances.