Neurosurgery Coding Alert

Question: How should I report frameless stereotactic surgery?

Texas Subscriber

Answer: "Frameless" stereotactic surgery involves placing tiny beads or screws (called "fiducial markers") that the neurosurgeon uses to identify radiologically the precise landmarks needed to calibrate neurostimulator placement. The markers serve the same purpose as a frame, but the physician can place them in advance (for example, the week prior to surgery) because they are very small.

There is now no dedicated code to describe placement of such markers. Therefore, the best code choice is 20999 (Unlisted procedure, musculoskeletal system, general). But there is no medical justification to report the placement of such markers separately. The national Correct Coding Initiative considers stereotactic headframe placement (20660, Application of cranial tongs, caliper or stereotactic frame, including removal [separate procedure]) integral to 61793 (Stereotactic radiosurgery [particle beam, gamma ray or linear accelerator], one or more sessions) and +61795 (Stereotactic computer assisted volumetric [navigational] procedure, intracranial, extracranial or spinal [list separately in addition to code for primary procedure]), which describe the surgery. Therefore, Medicare carriers may consider separate billing for fiducial-marker placement an attempt to unbundle.

Some commercial payers will reimburse separately for frame placement. In such cases, report 20999 with documentation that precisely describes the procedure and the amount of physician work involved so the payer can make an informed reimbursement decision.

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.