Neurosurgery Coding Alert

Question: We are billing CPT® codes 61510 (Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except meningioma), 69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) and 20926 (Tissue grafts, other [e.g., paratenon, fat, dermis]). The microscope is being used with 61510 for tumor removal. CPT® 61510 is listed in the Medicare Carriers Manual list of designated procedures that allow separate payment for use of the operating microscope.

Per CCI, CPT® 69990 and 20926 are bundled and no modifier is allowed. We have received numerous rejections from our managed care payers and our Neurosurgery Department would like to appeal on the basis that the microscope was used on the tumor removal which is a completely separate operative field than the harvest of the fat graft.

Our billing office disagrees with this logic because our understanding is the microscope is inclusive to the graft procedure and only one unit is allowed per operative session. So if we were paid for the graft, the payment for one unit of the use of the microscope is included in the payment of the graft.

Alaska Subscriber

Answer:

Billing the graft should have no bearing on the microdissection code used for the craniotomy. There is an edit between the graft and the microdissection because there is no medically-necessary indication for microdissection for graft harvest, not because it is an inherent part of the graft harvest procedure. You should bill the microdissection code immediately after the craniotomy code. If still denied, you have solid ground to appeal and explain in writing.