Neurosurgery Coding Alert

Question: Our neurosurgeon resected a frontal lobe astrocytoma using microdissection with an operating microscope and neuronavigation. How can we collect for this suite of services?

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Answer: You’ll report three codes for this service: 61510, +61781, +69990. The primary code, 61510 (Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except meningioma), describes the excision of the tumor itself. In addition, you should report +61781 (Stereotactic computer-assisted [navigational] procedure; cranial, intradural [List separately in addition to code for primary procedure]) for the stereotactic navigation and +69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) for the microdissection.

The Correct Coding Initiative does not preclude you from reporting 61510 with either of the add-on codes, but the CCI does bar you from billing both +69990 and +61781 together, noting, “Code 69990 is a column two code for 61781, but a modifier is allowed in order to differentiate between the services provided.” Therefore, if the surgeon has a medically necessary reason for using both the operating microscope and the computer assisted neuronavigation, you’ll append a modifier such as 59 (Distinct procedural service) to +69990. Both of these add-on codes are being reported with CPT® 61510, so review your EOB to confirm that both are paid because the add-on codes are mutually exclusive to one another but not to CPT^® 61510.