Neurosurgery Coding Alert

Question: Our surgeon used stereotactic navigation (61795) during laminectomy with fusion, instrumentation and cage placement, but the payer has refused 61795. Is this correct?

Missouri Subscriber

Answer: Code +61795 is an add-on code describing stereotactic computer assisted volumetric (navigational) procedure, intracranial, extracranial, or spinal (emphasis added), according to CPT. In addition, the National Correct Coding Initiative (NCCI) does not bundle 61795 to the laminectomy/fusion or instrumentation codes. Finally, stereotactic navigation allows the surgeon to place pedicle screws without damaging neuro/vascular tissues and thus reduce the risk of the surgery.

For all these reasons, the insurer should honor your claim for 61795 in this case, although many carriers are reluctant to pay for such navigation with extracranial or spinal procedures. You should appeal the insurer's decision, citing the CPT definition for 61795 and the inclusion of "spinal" in the code descriptor and requesting that the insurer's medical policy director review the claim.

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